My Journey to Becoming a Bonafide Truvada Whore

Truvada Whore: this term is meant to be derogatory and shameful. I've decided to embrace this name and take it's negative energy away. It’s been well over a month since I began taking the HIV medication Truvada (emtricitabine and tenofovir disoproxil fumarate) as PrEP (pre-exposure prophylaxis) a preventative measure.  It’s been an enlightening experience thus far.

My decision to begin taking this antiviral was an easy one. That is, it was never something that I struggled with decision wise. I felt like I understood the option and given my research interests and my identification as a gay man, the choice was easy. That is, the HIV epidemic is far from over and I am classified by the CDC as being part of a high risk group at risk for HIV infection.  It was exciting when the CDC and WHO recommended Truvada as a prevention tool.  How wonderful is this? I can take a pill that if taken consistently reduces my chance of HIV infection by ~92%. That’s fucking amazing.  Why wouldn’t I take it?  Perhaps this is similar to the choice that women were given when birth control pills became available in the 1960’s. “You mean I can take a pill that will prevent me from becoming pregnant? Pregnancy prevention is now under my control? I don’t have to depend on my partner using condoms to keep from becoming pregnant? “

Why would I not pursue this option? If I woke up tomorrow and there was an HIV vaccine available I would take it for sure. Until then, this is a powerful tool that is available to me. Wouldn’t you take it as well if you could?

It just makes sense, I want to be healthy, I want to remain healthy. I feel it is the right thing to do. It also adds an additional level of protection and peace of mind for me and my partner. I am in a happy and healthy long term relationship (2 + years) with the most fantastic guy in the world. He rocks my world. That is no bullshit. We communicated for well over a year before we ever met in person.  I think he wanted to be sure I wasn’t some Slim Shady. J  My guy is HIV positive. I knew this from day one as he was upfront about his status. It never entered my mind to not meet him because of his disclosure. It has never been a deciding factor for friendship or otherwise EVER.  It is a nonissue with me. To think of what I would have missed out experientially by allowing his HIV status to be a deal breaker is crazy. I cannot imagine not knowing him as I do. But I digress… but in all seriousness he is my sunshine, my only sunshine.

Taking Truvada has been a positive development for both of us. I’m taking medication that prevents HIV infection. He takes his HIV medications as part of his treatment plan. His viral load is undetectable. Current studies show that those on ARV therapies with undetectable viral loads cannot transmit the virus to others. Do you see where I am going with this? This gives us some breathing space and peace of mind.  I want to remain healthy, he wants me to remain healthy, and I don’t want him to worry about accidental transmission. So this is a definite win win!

I am quite familiar what the literature says about the side effects that accompany HIV medications.  I wasn’t sure what to expect, so I prepared myself for the worst.  I wouldn’t say it was the worst experience of my life, but I now have so much more respect and admiration for anyone on these meds.  For the first two weeks, I had a plethora of gastrointestinal issues. You know what I am referring to: diarrhea, nausea, vomiting, stomach and intestinal pain, and flatulence. Imodium became a constant companion. These negative effects stopped approximately two weeks after I began taking Truvada. I still have flare ups but it’s something that I can handle, and certainly not a reason to discontinue taking this medication.

I am only taking one pill daily. Many individuals taking HIV medications are on multiple drugs. These drugs can interact with each other and synergistically amplify negative side effects.  All I have to do is remember to take one blue pill at the same time every day (right before bed). Many HIV drugs can interact with other non HIV medications. I did an initial review of interaction concerns and to my relief; none of my other medications were listed. This is often not true with those taking multiple HIV related medications and this limits the specific medications that they can use for other health concerns. I have a much deeper appreciation for anyone on multiple medications.

My only sense of frustration so far has been with the medical/insurance industry.  This is my experience:

·         Calling my doctor’s office to set up an appointment, to schedule an HIV test, and to discuss PrEP  and having to explain in great detail to his nurse why I wanted to do this and what PrEP entailed

·         Contacting my State of Tennessee health insurance representative to inquire if Truvada as PrEP was covered by my health plan. Again, I had to educate the health representative via the phone as she was clueless

·         My physician, my gay physician  did not realize that Truvada was now recommended as a preventative tool – again this is my gay doctor

·         My health “coach” mandated by State of Tennessee Health Plan was ignorantly blissful concerning this issue. Not only that, but her uncomfortableness with the topic altogether was a huge irritation. She could not get off of our phonecall quick enough.

·         Lastly, the Walmart pharmacy where my medications are filled. I called beforehand to make sure that they carried Truvada and would be able to do refills according to schedule (Truvada only works best when taken consistently). I was assured that this was standard practice with them. I brought in my initial script and asked the pharmacy tech if they could fill the prescription that day. He assured me that they could and that it was in stock.  I returned later to be told that my script would have to go out for a “special order.” It would take no less than three days. I was furious with them. Yes, my panties were in a wad and here’s why.  Now granted this was my initial order. I could easily wait for my medications to come in and then begin taking it as directed. However, people living with HIV don’t have this luxury! Not taking medications daily contributes to drug resistance. That is, failing to take medications each and every day gives HIV the opportunity to develop drug resistance by allowing for replication. HIV is a sloppy virus, it makes numerous errors when replicating.  It more often than not makes a bad copy of itself. It is also a prolific little fucker, often producing nearly 10 billion virions daily. HIV has a high mutation rate therefore we want to limit the production of these virions.  Health providers are quick to point to patients not being medically compliant as a primary cause of drug resistant HIV.  How about the responsibilities of pharmacies towards their customers? The inability of pharmacies to provide medications in a timely fashion is abhorrent. I have heard this story over and over and over again from my guy and others. This is what got my ass in such a mess.

As for being overtly labeled a Truvada whore, it’s not happened yet. Or at least no one has opted to say this to me directly. Or maybe one of you out there online would like to take the first shot. Go for it.  I don’t understand the fuss. Is this a loss of social control? Would experts prefer that we remain wary about our relationships and our intimate expressions? Are self proclaimed relationship experts (many from conservative traditional ideologies) afraid that we may actually enjoy our sexuality and be happy? Is this a carryover from our Protestant obsession/revulsion of sexuality? If so, this is tiresome and I will not be part of this any longer. I imagine that when the pill first came out, there was a similar shaming of women. That is, a woman who has control of her body and thus can decide when she wants to be pregnant and when she doesn’t, well that woman is a danger to society status quo. The fear of pregnancy is no longer upon her. She will become promiscuous and an instigator. She might even want to come out of the kitchen and have her own career.

The shaming that I have read about the most seems to come from the gay community. Internalized homophobia shows its ugly head and is revealed for what it is, a way to keep MSM ashamed and in the closet. Taking PrEP should be applauded as individuals began taking control over their own health. Instead it  has become slut shaming and petty. Gossip and malicious talk are abundant enough in our community. What may be at play here is this: PrEP serves as a reminder of something that gay men don’t want to admit, that is, we are still at risk for HIV. Infections are on the rise amongst MSM, especially for MSM of color and this is difficult to admit.  It seems to confirm the nasty talk that still encircles us.There is still so much stigma concerning MSM and HIV.  We as a community have struggled under the weight of discrimination and outright prejudice regarding our sexuality and from a disease which has afflicted us disproportionately. As such, we have a real sensitivity to matters that come close to igniting these hateful and hurtful prejudices.  Again I will say, if there was a vaccine that conferred immunity to the HIV virus, would you not take it? Truvada is a tool that can prevent the spread of HIV and if you can take it, what is the harm? There is no shame, only that which we impose upon each other.

I have not had any negative comments made to me about taking Truvada. Instead I am met with silence.  I don’t hear banjoes playing, I hear crickets.  Sometimes it has been an uncomfortable silence.  I imagine that for some of my family and friends it might go like this “O hell, he said it. Now what? If I acknowledge this am I conferring acceptance? What if he talks about it again? Where is this conversation going? Is he promiscuous? Or does he have HIV and this is his way of telling me?”

It is important to acknowledge that Truvada is not accessible to everyone. I am taking it because my insurance plan covers it. What options do MSM have that don’t have insurance or who are underinsured?  The price tag associated with this pill is unbelievable (i.e., $1300 per month). The cost is beyond the reach of many people and in my mind this becomes a social justice issue. It bothers me that MSM who need it the most cannot consider this as an option. I did feel a tinge of guilt in taking it. Maybe I shouldn’t take it if everyone can’t have it.  Here’s how I resolved this conflict.  One of the participants from my dissertation interviews faced a similar quandary. He asked himself a similar question “why should I begin HIV medication treatment if people in African and America cannot afford to take these medicines?”  He sought the counsel of his pastor who very wisely stated “if you want to save the world, you will have to be alive to do it.” I must start with myself, and this was a step in that direction.  So to my fellow Truvada whores out there I say hello and kudos to you for your decision to take control of your health. And for all of those potential Truvada whores out there who might be deciding to take the medication plunge, come on over, you’re going to be in great company.