Pink, tan, white, powder blue.
Everyday I line up pills on my bathroom counter next to the pastel sink. As I pop each pill I try to recall why I take it. The pink one: my doctor prescribed for my nerves. The tan one is Vitamin C, that’s for strong immunity. Increased energy is why I take the white B12 pill. The powder blue one though... that's my pre-exposure prophylaxis (PrEP). I take that one so I can have healthy sex...or is it so I can have more sex? Or maybe I take it to protect the ones I love.
But it might be because I can afford it.
I’m not certain why I take PrEP everyday like a vitamin in preparation for a busy day ahead, whatever that may entail (presumably “PrEPpy” sex at some point).
The thing I do know is the blue one has sparked a national debate about what PrEP is actually being taken for.
Many critics say PrEP is a “party drug” that results in unsafe sex practices.
They point to a sobering 2017 study from the University of Los Angeles (UCLA) that suggests higher risks of other STI infections as a result of drugs like Truvada. In a research letter published in AIDS, UCLA doctors write that men who have sex with other men (MSMs) taking Truvada are “25.3 times more likely to acquire a Meisseria gohonorrhoeae infection, 11.2 times more likely to acquire a Chlamydia trachomatis infection, and 44.6 times more likely to acquire a syphilis infection.”
Activist groups like the AIDS Healthcare Foundation (AHF) say this study is proof that many are taking PrEP to have more bareback sex. Or is it to have safer bareback sex?
Not safe from infection though.
AHF director Michael Weinstein — who previously said Truvada was “a healthcare catastrophe”— clarified his stance in a statement to Business Wire “AHF’s position has been mischaracterize and criticized for our position on Prep, AHF’s mission and goal has always been to use scientific evidence to advocate for public policies that will inform and help protect the public from all STDs” and “This latest analysis should be a sobering wake up call for MSMs and other sexually active people that PrEP is not the magical panacea it’s promoted to be.”
There’s a tinge of finger wagging moralism buried in Weinstein’s public health platitudes that has other HIV/AIDS groups angry.
James Krellenstein, the founding member of the Prevention of HIV Action Group of ACT UP New York responded by saying Truvada “works”and that “we have to start thinking of it not as a luxury but as an essential public health component of this nation’s response to HIV.” Truvada’s — $1,600 per bottle out of pocket price tag — does make it seem more designer drug than life saving medicine. So while the Center for Disease Control (CDC) recommends 1.2 million high risk Americans, including 25 percent of sexually active gay men take PrEP, the reality is there are only 145,000 active prescriptions nationwide according to Gilead Sciences LLC, maker of Truvada.
Cost prohibitive access to PrEP means that it’s little effect on the HIV epidemic among black gay and bisexual men, who accounted for 44 percent of all new transmissions, and 44 percent of HIV related deaths in the US last year.
Dr. Demetre Daskalakis, assistant health commissioner overseeing New York City’s Bureau of HIV/AIDS Prevention and Control stated that "Black and Latino men are overrepresented in the epidemic, and have low threshold access to services.”
Daryl Hannah lost both his parents to AIDS by age 7. In his September 21, 2017 New York Times Op-Ed he wrote about why he took prep.“I had promised my parents that I would take every precaution against HIV, so I put enormous pressure on myself to take it [PrEP].”
Personally I’m still not entirely sure what I take PrEP for, probably a combination of things, but for people like Daryl, it’s being taken for one thing: to stay alive.
I know I’m being responsible by pitching in for public health, but I also know taking it may predispose unsafe sex.
Because PrEP didn’t just change my physiology, it changed my mind.
But I can always regain control by asking a simple question each time I pop that powder blue pill “what am I taking this for?"
Lucas Justinien Pérez is a New York based conceptual artist and writer that critiques contemporary society and “technologies of the self” in his work. Lucas holds a M.F.A. in Fine Arts from Parsons School of Art and Design. His art video entitled “The History of Rectangular Culture” was recently exhibited at The17th Street Gallery in New York City, and in August of 2017 his essay “Panoramic Rectangular Reality” was published in the Queen’s Museum’s “Panorama Handbook.” Lucas has been taking Truvada for 2 years.