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A Truvada Prescription Got This Guy Labeled a 'High-Risk Homosexual'

Photo by Joseph Osbourne

In his new memoir, High-Risk Homosexual, Edgar Gomez details the personal reckoning that came with being one of the first people on PrEP. Read an exclusive excerpt here.

Dr. Chen got highlights.

When I’d first met her at my college health center, she had a blunt, jet-black bob that complemented her trim, athletic figure. It was the perfect aerodynamic haircut for someone who wanted to get their work done and leave the room fast, which was exactly what I’d wanted too.

Back then our consultations had the no-nonsense air of a trial. I presented my case—I am a gay man who would like to have some gay sex—and she filled out the necessary paperwork to make that happen. She did not ask why. She did not even think it, because the character of her in my mind had no thoughts. She was no more sentient than a webpage.

But now, after a month of appointments during which I’d told her more about who I’d slept with than I had my closest friends, there were chunky streaks in her hair that could aptly be described as honey. I wasn’t unreasonable. It wasn’t that I didn’t want Dr. Chen looking cute. It was just that what we were doing here was easier when I could pretend she was above such trivial, human concerns as highlights. If she had thoughts about her appearance, it meant she was capable of having thoughts about other things, like her patients. Did she think me and my gay sex were disgusting, or weird, or funny? Who was she if not a webpage that couldn’t judge me?

“I’ve been having nightmares,” I told her.

She typed this into a form on her computer, then adjusted her rolling chair so that her feet brushed back and forth over the ground. I recognized her shoes. I’d sold hundreds of them at the flip-flop boutique where I worked before grad school. They were white espadrilles with yellow polka dots, made by one of those companies that promise that with each purchase, a pair will be donated to an orphan somewhere hot with hard, clay earth. My chest felt lighter. She cared about orphans. She probably was a normal amount of homophobic. Fifteen percent. She’d cry if one of her kids came out to her, but in her room.

“Nightmares,” she repeated.
“Yeah. Almost every night for the last two weeks.”

One of her eyebrows went up. The movement looked rehearsed, like a trick she’d learned in medical school meant to convey the proper level of concern. Everything about this visit had a trace of acting to it. I requested a drug I didn’t technically need. She responded by reading questions off a script. “Do you prefer to give or receive?” she’d asked during my last visit, as if the question weren’t about anal but my philosophy on Christmas.

She sighed and turned to her computer, presumably to check whether nightmares were a symptom of the medication she’d prescribed me. Privately I scolded myself for bringing them up. They weren’t supposed to become A Thing, not when my being here was already A Thing.

I was one of her first patients on Truvada, commonly known as PrEP, the one-a-day antiviral pill that has been shown to reduce your risk of HIV infection by nearly 100 percent. As of 2017, it had been used for over a decade by HIV-positive people to treat the virus, but it wasn’t until 2012 that the FDA approved it for use by those who are HIV-negative as a means of prevention. Even though PrEP had been available for five years by the time I met Dr. Chen, the drug’s manufacturer reported that between 2012 and 2014, only 3,253 people started the PrEP regimen. It was expensive ($1,300 a month without health insurance), and so new, so risky. It wasn’t clear what an antiretroviral medication would do to an HIV-negative body. It still isn’t.

Which was why I needed to be the perfect gay male specimen for Dr. Chen. If I showed too many negative side effects, I worried she would hesitate before prescribing PrEP to other queer people. I had forgotten there were times when I spoke for myself and times when I spoke on behalf of all gay men. I wouldn’t slip up again.

“It’s not a big deal,” I told her. “I googled it. Aren’t nightmares common for the first few weeks?” I knew they were. I’d assumed she did as well, considering she’d prescribed the drug to me. The nightmares weren’t that bad anyway. In my last one, Mariah Carey tried to eat me with an ice cream scooper. I kind of looked forward to them.

“Yes, you’re right. Nightmares are normal,” Dr. Chen said, reading from her screen. She went through the list of other symptoms I might expect: Fever. Headache. Vomiting and diarrhea.

“Night sweats, sore throat, tiredness,” I added. “I feel fine.”

None of these bothered me when I researched PrEP on my own. I didn’t care if the pills made me projectile vomit diarrhea out of my sore throat. Soon I would be able to date without worrying about the virus that decimated the generation of queer people who came before me. As long as I could find someone who didn’t mind my incontinent mouth, it’d be worth it.

“It sounds like you know what you’re doing,” Dr. Chen said, rolling away from her computer. We began our recap.

“How many partners have you had in the past month?” she asked.

A poster on the wall listed the effectiveness of various birth contraceptives, ranking them with gold stars. Condoms, male or female: one gold star. Diaphragms: three gold stars. Pulling out: no gold stars. A crude drawing of a hand with crossed fingers represented just how few stars the pulling-out method deserved.

“Like, boyfriends? Or intercourse?” I don’t know why I asked for the clarification. The answer would have been the same either way. None. I hadn’t had sex in months.

“Intercourse,” she said. “How many partners have you slept with in the last couple of weeks?”

I hesitated. If I answered none, would she think I didn’t need PrEP and take me off the medication entirely? I hadn’t been sexually active lately, but what if I met someone? Would a condom be enough to protect me? The poster in the room said it was a one-star contraceptive.

“Two partners,” I blurted out, figuring that was better than nothing.

She wrote the number in my chart.
“Did you use protection?”
“Yes,” I answered.
“And did you pay either of them money in exchange for sex?”


“Okay.” She took a deep breath and giggled as if she were about to ask for my autograph. “I’m sorry, but I have to ask. You didn’t meet either of your partners online or anything, right?”

“No,” I said again.

She lowered her pen to my chart once more, muttering “Didn’t meet partners online” under her breath, then added, “Good, good.”

All of this was standard protocol. Part of the agreement we made that I would meet with her every few weeks to recount my latest sexual activity and check for liver damage—a potential side-effect of the drug. It took two weeks for the antiviral to reach a high-enough level to fight HIV, and about two more for the nausea and nightmares to disappear. With my first month behind me, it was time for her to hold up her end of the bargain—another bottle of PrEP.

“You doing all right?” she asked.
“I’m doing all right,” I told her.

I would be, once she handed me my permission slip to go off and have fearless sex. We sat quietly as my prescription printed line by line.

Before I could read what was on it, she folded the paper in half and pressed it into my palm. It wasn’t until I made it home twenty minutes later that I opened it. My first thought was that there’d been a mistake, that I’d gotten someone else’s diagnosis.


Dispense to Edgar Gomez

Twenty-Five Years Old

High-Risk Homosexual


There was my name. That was my age. But “high-risk homosexual”?

Girl, where?

According to the fake sexual history I’d given her, I’d slept with just two men in a whole month. Men I’d supposedly met in person, not in seedy parks or truck-stop bathroom stalls or wherever else “risky” people hooked up. I didn’t pay. I used imaginary condoms and everything.

What about any of that made me a high-risk homosexual?

I dug through my desk drawers looking for my original prescription. There I found myself again, buried under loose paper clips. Edgar Gomez. High-risk homosexual. So there wasn’t a mistake. She meant it. How hadn’t I noticed that before? I must have been so thrilled to qualify for PrEP on my initial consult that I didn’t bother to read the fine print.

Sitting alone in my bedroom, suddenly I felt exactly as I did in high school the day that I went to my guidance counselor’s office to discuss college. I’d gone into the meeting figuring we’d talk about my strong SAT scores or the several college-level courses I’d taken. We did briefly, but then the conversation turned to financial aid, and my counselor began listing all the different scholarships available to me: for being gay, for being the first generation in my family to be born in the United States, for living in a single-parent household. I was grateful there was money out there, but I couldn’t help resenting what I believed I had to do to accept it, which was to take those things I’d slowly begun to take pride in—my queerness, my family’s migration—and claim they’d put me at a disadvantage. In many ways they did, but I wasn’t ready to admit that. It seemed cruel, after all the work I’d put into loving myself, that the final step left between me and going to college was writing several five-hundred-word personal essays about how much my life sucked.

Though I hated being reduced to a narrative of victimhood, my counselor wasn’t wrong to assume I needed help. The truth was that I couldn’t have afforded to go without aid, so I put my pride aside and applied. And it was this same truth that I was learning again years later: my story wasn’t just mine; who I was resided somewhere between how I saw myself and how everyone else—my counselor, the organizers of those scholarships, Dr. Chen—did.

No, I didn’t think I was high-risk, yet at the same time: Could I afford to say I wasn’t?

From High-Risk Homosexual by Edgar Gomez. Used with permission of Soft Skull Press. Copyright © 2022 by Edgar Gomez. 

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