PrEP: Room for debate

[FindingNamo]

Posted: 6/18/14 at 1:44pm

The NYTimes Opinion Pages "Room for Debate" section takes on the issue of Pre-Exposure Prophylaxis (taking a pill a day to prevent HIV infection), a topic we've discussed on here. The headline given the section is off, no one is suggesting that "a pill a day is enough to fight HIV," but that's how they framed it. Dr. Ken Mayer has always been my go-to source as I educated myself on the issue, because he has been on the front lines of this research from the beginning.

But what would any discussion about this be without the voice of Larry Kramer? His piece is called "We don't know the full story yet," which is true, but you don't ever know the full story when researching and developing new tools. That's the point. At least this time he manages not to call the heroes who have pitched in on this "cowards.' He *does* seem to conflate PrEP with PEP (post-exposure prophylaxis, given for a month after a person has been exposed to HIV). Naturally, his homophobia is there, too. He makes it clear the exact circumstances he finds the notion of PEP palatable: "Truvada could be useful for health care professionals who are exposed to H.I.V., as a prophylactic day-after pill." Yes, Larry. That has been the protocol for YEARS, I've done it myself even though I wasn't an innocent health care worker, but rather a murderous/suicidal gay man who had a condom failure! I presume that's how he would describe me.

Anyhoo, here's the page… something to talk about this Pride month.


Room for debate

Updated On: 6/18/14 at 01:44 PM

[SonofRobbieJ]

Posted: 6/18/14 at 2:08pm

This has been a lot on my mind lately. I've discussed with my doctor the possibility of going on PrEP, not sure how he would respond. He's enthusiastic about it. But I still find myself having an internal debate. I've made it to 40 without becoming HIV+ through safer sex practices. But I do know that I've made some choices that increased my risk of exposure and will probably do so again. I have concerns over long term exposure to this medicine (any medicine, really), and I don't always remember to take my vitamin, so there's that, too. But having concerns and being able to get as much information as possible in order to make the right choice for your sexual health is something that is made that much harder by the hard-liners who use the words 'coward' and 'whore'.

I have no desire to run out and 'bareback,' or, you know, have sex naturally without a barrier (does it really need a special name that some find hot and I find icky?). But I do know I would like options when it comes to taking charge of my sexual health. Let's hope this is just the beginning of a much more nuanced conversation about how to navigate the world as a gay man and remain HIV-.

[FindingNamo]

Posted: 6/18/14 at 2:16pm

Well, you just helped this discussion be more nuanced thanks to your honesty.

It kind of would make a funny sketch:

Patient: Doc, I'm not sure what you might think about this and I am kind of nervous to bring it up but I want you to know I've been thinking about PrEP--

Doc: OH MY GOD THAT IS A FANTASTIC IDEA! I'm so glad you brought that up! Let's get some cake! This is the perfect thing for you and will be so good for the community at large.

[SonofRobbieJ]

Posted: 6/18/14 at 2:24pm

At the end of the skit, can he call me a whore and we just fall out giggling. Like Oliver from TRUTH OR DARE?

[Brian07663NJ]

Posted: 6/18/14 at 2:54pm

The rule of thumb I practice with my doctor and one I tell everyone - if you are afraid or embarrassed to tell your doctor...then don't do it.

Whatever you are doing sexually - be prepared to tell your doctor without hesitation in complete detail. If you fear your doctor is going to judge you or criticize you then you need a new doctor. Your doctor should be your wing-man to maintaining your health and not your judge or parent.

[FindingNamo]

Posted: 6/18/14 at 3:00pm

Wait. I'm reading your rule of thumb as something different than the second paragraph. I'm totally on board with the idea of the doctor being one's wing person but I also understand that doctors are people and sometimes we have lifelong relationships with them and the world isn't perfect and sometimes we feel we can't tell them everything. The moral being you need somebody you can tell everything without fear of being judged and stigmatized. Not everybody everywhere has access to such doctors, unfortch.

"Like Oliver from TRUTH OR DARE?" It'd be sublime if the doctor told you take a poll and it infuriated you.

[Brian07663NJ]

Posted: 6/18/14 at 3:23pm

Sorry for the misunderstanding...

The first paragraph should read:
The rule of thumb I practice with my doctor and one I tell everyone - if you are afraid or embarrassed to tell your doctor...then don't do the sexual or fetish item you planned to do.

I see your confusion... then don't do it did not mean... then don't tell your doctor.

[FindingNamo]

Posted: 6/18/14 at 3:24pm

Then I disagree with your first paragraph! If you want to do something you're ashamed to tell your doctor about, find a better doctor!

[Brian07663NJ]

Posted: 6/18/14 at 5:25pm

Yes Namo... We are in agreement - or find a better doctor.

[FindingNamo]

Posted: 6/18/14 at 5:47pm

Like the folks who say, don't take a photo of yourself you wouldn't want your mother to see. I don't see why the one is dependent on the other.

[HorseTears]

Posted: 6/19/14 at 4:26am

I'm going to be moving from an employer program to Obamacare later this summer (ah, work transitions!)

Any tips - preferably for those not making six figures (yet?) - on finding a gay-friendly primary care physician? Is there a particular org, ranking system? I mean, other than Yelping "gay friendly physician".

[FindingNamo]

Posted: 6/19/14 at 10:08am

Are there any health clinics where you are that have a large LBGTQ client base?

[SonofRobbieJ]

Posted: 6/19/14 at 11:01am

Do you currently have a gay-friendly doctor that you'll be losing by making the move from employer-based to Obamacare? I've actually had the talk with my doctor (whom I love) because I'm considering leaving my job and devoting my time to the production company my friend and I have started. He said that if I make that choice, I can go through the options of plans with one of his staff and find one that would work best for my budget and my care. He's just delightful.

Are you in a major city that has a GLBT health center?

[HorseTears]

Posted: 6/19/14 at 7:46pm

I'm in a small town in the west called Los Angeles. I don't think it should be difficult to find a gay-friendly doctor here. It just might be slightly more challenging if one doesn't live in WeHo or Beverly Hills and drive an Audi and is not paying for a premium high-end plan.

And, no, I'm not really losing a gay friendly physician. It's not that my primary care physician is unfriendly, though. I've just seen him only three times in the last three years and never had any gay-specific conversations. And it's not that I was afraid to - it's just that I barely saw him and only when I was nasty sick - bronchitis etc - rather than for "normal" regular check-ups.

But, moving forward, I'd like to take a more active role in my health - not getting any younger here - my 20s are now a few years off. But, I'm also probably not going to be buying the premium/platinum Obamacare plans either. I'll just check with the LGBT Center to see if they have any resources.

Updated On: 6/19/14 at 07:46 PM

[GavestonPS]

Posted: 6/21/14 at 9:16pm

HT, I sent you a PM about my experiences (largely good) with BlueShield and Covered California. From one Californian to another...

[HorseTears]

Posted: 6/22/14 at 3:00am

Cheers, Gav!