Op-Ed: I'm on PrEP and I'm Not a Slut

I'm HIV-negative and I'm on PrEP.

Why am I sharing this very private piece of medical information? If you're HIV-negative, then I want you to be on PrEP, too. Yes, you. I don’t even know who you are, but you owe it to yourself to consider it. 

PrEP, or Pre-Exposure Prophylaxis, is a drug regimen that was approved for use in America in 2012. Although other options are in the pipeline, currently the regimen involves taking Truvada, a one-pill combination of two types of medications that are usually used to treat HIV after infection. Studies have shown that if relatively healthy people who are HIV-negative take the drug correctly, it can be almost entirely effective in preventing HIV infection. In fact, in a recent study of people on PrEP, no patients who used the drug correctly contracted HIV.* This indicates that it works.

Another study released in the Oxford Journal concluded that short-term daily usage of Truvada had the same low-impact on the body as an aspirin.  This shows it's safe.

PrEP is a huge development in the fight against HIV. It could potentially eliminate the disease, or at the very least reduce the number of new infections every year. If it works and is safe, why aren’t more people on PrEP? Why isn’t everyone on it? 

My uncle contracted HIV in the 1980s during the early days of the virus when it was considered a “gay plague” and an almost certain death sentence. I'm a part of the first generation of people who have never lived in a world in which HIV wasn’t a consideration. My uncle eventually died in the 1990s from complications related to AIDS. He was the last to die among his circle of friends who all succumbed to the disease — part of a generation of gay men that our community lost. Over 30 years and 40 million deaths later, we still have no cure for HIV. If it were 1981, people would be breaking down the pharmacy doors trying to get this drug. But in 2016, many at high risk for infection still have never heard of PrEP, Others seem unconcerned with possible infection, perhaps due to improvements in HIV treatment and increased quality of life for those who are HIV-positive. Common sense would seem to dictate that PrEP become part of more of our lives. So what's getting in the way of common sense? Shame.

Shame has likely lead to more infections than any other reason, because it prevents people from becoming more proactive about their sexual health. HIV and being HIV-positive has always carried a harsh stigma with it. The criminalization of people living with HIV has contributed to this, as well as our fear and prejudice about the disease. In some circles, it is commonplace to ask someone if they are “clean” — code for HIV-negative. This implies that being HIV-positive is “dirty.” Many people still believe that HIV-positive people did something to "deserve" getting HIV, or that being HIV-positive means you were a slut, a drug addict, or both. 

I imagine there isn’t a person on the planet who hasn’t either been called a slut themselves or assumed that someone else is. The dictionary tells us that a slut is “a promiscuous woman.” How’s that for sexism? For the sake of argument, let’s expand that definition to include men. Accusing someone of being a “slut” has been an effective way of shaming people into submission since the term’s origin in the 1400s. Our communal, societal fear of being condemned as “sluts” ourselves may lend itself to the misperception of people on PrEP being sluts. 

This is unfortunate, because, quite the contrary, people on PrEP are being the opposite of slutty. They are being responsible. They have empowered themselves by taking control of their health and their sexual identity. I didn’t really understand that until I decided to get on PrEP myself. I reached out to Legacy Community Health Services in Montrose, Texas after my own physician seemed uninterested in talking with me about PrEP. This is apparently commonplace, as many doctors are not well-educated about it. I called Legacy and set up an appointment for the next day with a patient navigator. You do not need health insurance to access PrEP at Legacy, although it does make it easier. I filled out some paperwork and then received information about the drug. Afterward, I was sent to the on-site lab where I had blood drawn and a urine sample taken. To get on a PrEP regimen, I was tested for HIV and every other sexually transmitted infection (STI) initially, and will be again every three months. This ensures that I haven't been infected with HIV or any other secondary infection that may require treatment. PrEP only prevents the transmission of HIV. It will not prevent other STIs, like drug-resistant gonorrhea. It is still recommended that patients on PrEP use condoms, but part of Legacy’s realistic approach to healthcare is understanding that not everyone will adhere to that. People who aren’t using condoms without PrEP will likely not use condoms while on PrEP. 

Roughly two weeks after my blood was drawn and tested, I had a second appointment with a Legacy doctor. At this appointment, I received another rapid HIV test. It’s a lot of testing, because PrEP, when administered to someone who is HIV-positive, will not effectively treat their infection and they could build up a resistance to future treatment. 

I tested negative again. HIV testing is never without stress, even when you know you are negative. I always wait for the results holding my breath. My doctor asked me some more questions about my health and provided more information about the drug. I was then sent down to the on-site pharmacy to pick up my prescription. Legacy, through a grant with Gilead, the company that makes Truvada, provided me with a coupon that saves me from paying any required copay. Let me repeat that: PrEP was completely free for me, and took a total of about two hours of clinic time. 

You may be reading this and thinking that I must be a slut because I decided to get on PrEP. If so, that’s cool. Maybe I am, or maybe I’m not. Frankly, my dear, I don’t give a damn. As my mother always said, “What other people think of you is none of your business.” 

What I do know is that I'm doing everything I can to prevent the spread of HIV, and if that means people think I’m a slut, then I’m okay with that. I’ve probably been called worse things by better people anyway. But if I have somehow convinced you to at least look into getting on PrEP, then you should know that you aren’t a slut either. In fact, whether you go on PrEP or not, you are not a slut. You can be on PrEP and never have sex with anyone, or you can have sex with everyone in town, and you still won’t be a slut. You can also keep whether or not you are on PrEP entirely to yourself, or write an article that is published and shared with the world! It doesn’t really matter. It’s no one else’s business. If you are being responsible to yourself and your partner or partners, then that’s all that you need to worry about. 

And by the way, people who call other people sluts are insecure and need to find a hobby.

Ryan Leach is a community leader who enjoys oversharing and encouraging people to be kinder to themselves and their community. He is not a slut, and neither are you. Feel free to email him at ryan@outsmartmagazine.com.

*EDITOR'S NOTE: There has been one case of a person contracting HIV while adhering to their PrEP regimen. Read more here.