PrEP ... at 71? 

This 71-year-old gay man is HIV-negative. I’ve remained uninfected throughout the 1980s, despite being sexually active and burying my AIDS-riddled lover in 1988. Since then, I have had wonderful partners, some positive and some negative, all cherished.

Saying goodbye to dozens of 20-, 30- and 40-something-year-old friends who died was incentive enough to “play safe.” However, fighting grief, survivor’s guilt, anger, and the general message that we were all doomed was not an easy path to negotiate. I had to learn how to use condoms properly and to be sex-positive in an era of confusion, fear, and horror. I have overcome those barriers to a healthy relationship and sex life. Now here comes Truvada, a drug approved for pre-exposure prophylaxis (PrEP), to help men like me remain HIV-negative. Finally, we have a real opportunity to eradicate HIV infection and AIDS.

What should I do?

It’s hard at 71 to have a meaningful discussion about my options regarding PrEP. Neither my primary care doctor nor my urologist was forthcoming about their thoughts. They either warned against side effects or suggested the HIV clinic. Really?!

I am not a novice to these discussions and first started working in the HIV/AIDS field in 1983 when the National AIDS Hotline was established. I joined ACT UP New York soon after its inception in 1987. I have lectured and trained about HIV prevention in a number of countries and was the director of HIV/AIDS Program Services in the United States. The résumé goes on, but that is not the point of the article.

What do I do now?

I live in Palm Springs, Calif. Here, on any given day, you can see dozens, if not hundreds, and even thousands of my contemporaries. As I explained to a younger visitor recently, when he remarked at the number of older men he was seeing in the varied venues, “What you are seeing are the survivors. Each of these men has a history that is filled with sadness, grief, and the strength needed to fight through the emotional pain to remain upright, with dignity and their 'gayness' — whatever that is — in place.” Many of these men are HIV-positive, managing their infection. Others, like myself, remain HIV-negative.

Given the demographics of my community, I am assuming I cannot be the only one with this dilemma: Do I take Truvada or not?

I have recently developed a meaningful relationship with an HIV-positive man. Safer sex and condoms are part of our standard practice, but what do I do about this supposed 99 percent sure thing? Don’t get me wrong. I love the idea that there are solutions that can work. I am 100 percent for it. Yet I need to consider if Truvada is right for me?

It seems, from my own experience and those of my contemporaries that medical appointments for any number of issues are, shall we say, “age-appropriate.” There are blood tests and urine tests and X-rays and MRIs. The list goes on. Do I really want to start a regimen where additional monitoring is necessary? Do we know what the long-term effects are on older gentlemen who are already on a myriad of anti “this” or anti “that” medical protocols? Of course, we know that PrEP does not stop other sexually transmitted infections, and condom use remains encouraged.

OK, so we know all this, but what if I do not submit to the current pressure to swallow yet another pill or get an implant when that becomes available, and I then get infected?

Well, now hear me out. Despite the current practice to get the newly infected on medical treatment, we know it takes years from the initial exposure to HIV until the first symptoms make themselves known. This could be as long as from eight to 12 years, or even 15. If you are a nonprogressor — as we called it years ago — never. Seriously, those dates would put me into my 80s, if I live that long. Absolutely, if I were in my 20s, 30s, 40s, 50s or 60s, I would jump on the opportunity, but in my 70s, I’m not sure.

After what has been a 35-year career of fighting for a cure, a vaccine, and a ;prevention option, I rejoice that HIV infection prevention is now possible. Sadly, I wonder if it may have come too late for those of us experiencing the effects of aging.

STEWART SOKOL, Ph.D., served as the supervisor for the National AIDS Hotline and Los Angeles County Commission on HIV Health Service. He is a lecturer and consultant on issues affecting sexual minority youth and members of the LGBT communities for LGBT-TRISTAR, ONTRACK Program Resources, and Center for Applied Research Solutions. He is also a trainer ;for the California Office of AIDS and advisory board member for Harbor-UCLA Medical Center’s Women’s Healthcare Clinic. He is the former director of HIV/AIDS Program Services.