For years, PEP(Post-Exposure Prophylaxis, not to be confused with PrEP) has been available. It initially became available to health care professionals, who would be given PEP, in the form of antiretroviral medications(aka HIV meds) after being exposed(or possibly exposed) to the HIV virus at work(through needle sticks etc), in order to prevent said workers from seroconverting (that’s becoming HIV positive to you). It was found to reduce the chances of HIV infection by 80%. PEP was then made available to the general public and the guidelines were(and still are) that in order for it to be effective, antiretroviral treatment(HIV meds) should be given within 72 hours of possible exposure to the HIV virus. This is where Brazil has the upper hand, because they started giving starter packs, so that PEP could be started asap, before getting to the doctor, who would then prescribe the full month’s supply needed for PEP. So why am I talking about PEP and not PrEP? Because I think it is important to know the difference and in order for PrEP to have any significant effect on the black gay community(and the black community as a whole), more outreach work will need to be done for PrEP, than was done for PEP. Most black gay and bisexual men I speak to have never even heard of PEP. Once again, another reason why it is important to have an honest and good relationship with your health care provider. We must also be responsible for our own lives and our communities. The information is out there, you just have to find it. As I have often said, if you can find men online, you can find information that just might save your life.
I don’t want to turn this into a confusing medical journal, but just to be clear, here are the differences. PEP is given(in the form of one month’s supply of HIV meds) within 72 hrs after exposure or possible exposure to the HIV virus, in order to reduce the chances of seroconverting(becoming HIV postive) and is available to the public. PrEP is NOT YET available, but the latest results of trials done with gay and bisexual men, who were given Truvada(which is a combination of two antiretrovirals - Tenofovir and emtricitabine) were very promising, so it is only a matter of time before some form of PrEP becomes available. PrEP would be taken daily in order to significantly reduce the chances of seroconverting, should you be exposed to the HIV virus. Neither PEP nor PrEP are guaranteed 100% effective(by the CDC) and should not be seen as a license to become a reckless, voracious barebacker (unless of course, that is what you choose to do and are prepared to live with the consequences). I am excited about the impact PrEP could have on the stress levels of serodiscordant couples(one positive and one negative) – just being able to reduce some of that anxiety would be HUGE.
Now that we are clear about the differences between the two, I would like to explore a few points and ask some questions, which hopefully some of you will respond to. With lack of adequate health care and other issues such as homophobia and the resulting denial, which plague our community, black gay men (MSM and black men in general) have notoriously been late presenters, when it comes to HIV/AIDS. Meaning a lot of us often don’t get diagnosed as HIV positive until our immune systems are severely compromised. Many go from being unaware of their status(or living in denial) to an AIDS diagnosis. We are also not that good at taking control of our lives and being more proactive, when it comes to our health. 30 years into this epidemic, I am often alarmed at how little many of us seem to know about HIV/AIDS, treatment options and resources available, let alone PrEP or PEP. We seem to be more interested in hook-up sites than living long fulfilling lives. A lot of black gay and bisexual men can find their way around A4A and BGC, but very few of the same men are armed with the knowledge needed to stay healthy in 2011.
Will black gay men be willing to take PrEP or even absorb the information that PrEP is available, when it does become available? Would YOU take a pill everyday to reduce the chances of seroconverting? It is a very personal matter and each individual must decide what works for them. Antiretrovirals aka HIV meds are not without side effects, so we have to weigh the pros and the cons. However, HIV and AIDS are still VERY REAL, there is no cure(no Magic Johnson isn’t cured) and living with HIV is no ride in the park. Go talk to honest people living with the virus, go on a doctors visit or two with a friend and look at the faces of those in the waiting room, go volunteer at your local HIV/AIDS organization and talk to people. That’s how you REALLY find out the impact HIV has on lives and it is not just the physical aspects, it is the stigma, the loneliness, the depression, the possible loss of friends and family. Get the picture? It is not the same picture painted by the drug companies on all those posters with sexy, muscular men looking like they don’t have a care in the world. Yes, some people with HIV have a relatively easier ride than others, when it comes to illnesses and side-effects, but there is still the stigma, especially in our community.
If you are a sexually active black man who sleeps with men, you have probably had sex with an HIV positive individual within the last six months or 1 year – depending on how rampant you are. HIV/AIDS has ravaged our community, yet black gay men still continue to use certain words which perpetuate the stigma associated with HIV/AIDS. He has “the beast”, “the monster” or “why are you talking to that dude, you know he is positive, right?”. Always makes me wonder, last time you spread your legs for a stranger or ran all up in someone, did they provide you with paperwork proving their HIV status? I doubt it – and a lot of us are having or have had raw sex, let’s just be real. When was the last time YOU had a test, have you had a test since your last unprotected sex escapade? So with all this stigma and ignorance still so rife in our community, do you think PrEP will take some of that away? Would you date someone(a great man who is everything you have ever prayed and wished for), who was HIV positive if PrEP would reduce a lot of the anxiety associated with serodiscordant(get used to the lingo people) couples? If PrEP were available tomorrow, what impact do you think it would have on you and your prejudices towards HIV positive black men? Would the previously “undateable” now seem more attractive? How do you think PrEP would affect your dating, sex life and relationships?
Antiretrovirals(that’s HIV meds – I’m drumming these terms in, so that down the line, we can just use them, without having to explain what they are) are not cheap and PrEP and PEP mean taking HIV meds. Unless they come up with some kind of funding to subsidize high-risk groups, if you don’t have health insurance or a stack of cash in the bank, you probably won’t be able to afford it. Truvada can cost anywhere from about $860 – $1080 for a months supply. I’m sure they will have to come up with some kind of subsidy for PrEP, but you get the picture. Access to adequate health care is already an issue in the black community. How will this affect the impact of PrEP on our community? I want to play devil’s advocate for a minute – I often do that without you guys even realizing. Say, PrEP were offered in a certain state at a subsidized rate or free( we can hope) to gay men – would you be willing to move? Remember, it’s your life and your health we are talking about. Gay men are often called creative(which of course isn’t always true, but let’s stay with the stereotype for a minute), so why is it that some black gay men don’t seem creative when it comes to finding a job or making money? What are your skills and would you be willing to learn some new skills, in order to be able to afford PrEP? I’m having a little fun here, but I am also being serious at the same time. PrEP might become our only hope until there is a vaccination for HIV. There are a lot of black gay men running around the clubs and bars in the latest gear acting all fabulous. Why not be fabulous about your health care? Instead of sitting at home broke, yet smoking a blunt, would you take on a part-time or full-time job at the local grocery store, fast-food chain or Home Depot, if it meant health insurance and access to PrEP?
As far as the conspiracy theory goes and our distrust of health care professionals(as a reason for not taking meds), as I was writing this, I decided that deserved its own blog post in the future. This one is long enough as it is, so we will explore that at a later date. All I know is that the people I have known who chose not to take their meds(and/or alternative antiviral therapies) and never went on their doctor’s visits are either dead or fighting for their lives as we speak.
PrEP Resources: AVAC.org | CDC PrEP Fact Sheets | SearchForACure.org
If you are reading this and had never heard about PEP or PrEP, it is never too late to take control of your health, become more proactive and dedicate a couple of hours each month to researching health related issues. We spend enough time online anyway, so how difficult would it be to take a few hours out of your monthly online time to empower yourself? Your online life should not consist solely of hook-up sites, porn, Facebook and Twitter. PEP has been available for years and most black gay men I’ve spoken to had never heard of it. We can’t rely on funds being made available for outreach work in our communities, we have to become our own health advocates and take control. Black Gay Men’s Blog is about us sharing knowledge and empowering one another, but you have to be willing to do some of the work. Even when we have a full team of regular blog contributors, we will only be sharing our perspective – with the hope that others will comment and share theirs. We all have individual health concerns and needs(not just HIV) and it is up to us to research that information and then, armed with more knowledge, be able to take a more proactive role in our health care.
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another great post man – we missed u last week lol!
thanks for this info. gotta admit, I didn’t know about PEP or PrEP. Why don’t they have this stuff posted in doctor’s offices? I guess they ain’t got it where black people go(where it is needed most). Can’t believe I’m just now finding out about this ish – mad and glad at the same time.
keep up the good work!
This is why I say to all men who sleep with men and black gay men in particular – the family Doctor who treated you when you were 8 years old, might not be the right fit. Some doctors do have PEP info posted, but I guess it all depends on the doctor and how “relevant” he or she thinks HIV info is to the patients, or their own views on PeP etc. I agree it should be made more widely available in the black community, especially if and when PrEP becomes available. Again, another reason why I believe in being honest with primary health care physicians – some might falsely believe “this is not a real issue in this community or for my patients” etc. Doctors are human, they make mistakes and sometimes even misguided decisions, based on personal beliefs.
damn, sounds like this PrEP is gonna be something to think about.
Would I take it? Hell yeah! but I don’t think a lotta black men – gay, bi, str8 whateva gonna take it. they gonna have to do some serious education, when u think about the way some of us think. Now, u just know some black folks gonna say they made PrEP to kill us off LOL.
PrEP ain’t really gonna affect my dating or sex life. The way I look at it, we’ve all had sex with a positive dude, some of us are just in denial. a lot of us have had RAW sex with a positive dude – yeah I said it. Y’all know what’s really going on out there – Magnum sales must be down yo, coz ain’t a lot of those popping out these days, like a few years ago.
Ain’t never had a issue with positive dudes, coz the way I look at it -people in glass houses……… Plus at least they know their status – majority of the freaks out there can’t say 4 sho if they poz or neg.
Just keeping it real, I done lucked out so far. If PrEP is available, i’mma take it like candy.
#justsayin
thanks mah dude! it was a long read, but I’m glad I read it ALL. I say this brutha gone make me buy a medical dictionary lol. nah 4 real we need to know all this terminology.
being honest, I heard about PeP but never really knew what is was and I ain’t never know nada about PrEP trials etc. I’m with Lamarr on this one – the minute they bring this PrEP out, i’m gonna be on it like white on rice! Yeah, I got me a job, so I got insurance LOL. Yo on the real, for my dudes out there try and get a job, any damn job, so we can have health care. this shit is REAL man!
why is it when I come on here, I be trying so hard not to use the “n” word LOL? Yo, this brutha Storm man, I don’t know u, but thank u for doing what u doing! U ain’t lying – WE GOTTA TAKE CONTROL
I dunno man – appreciate the info, saw the link on facebook, but I dunno. I’m one of those people, I don’t trust these people man. I mean, yeah it will be cool to have something to reduce the risk, but you know they don’t like no black poeple. They probably got a Truvada for blacks. Yeah I know I sound crazy, maybe I just need to read more and talk to folks who know more about this stuff. At least I read this article, but like I said I dunno about taking no Truvada man.
Damian, sometimes doing more research makes me feel more comfortable with whatever decision I need to make. PrEP is definitely not for everybody, but “Truvada for blacks” seems a little far-fetched, but you know that already. If and when the time comes hopefully, you’ll make an informed decision that works for you.
call me ignorant, call me what u want but I ain’t taking no goddamn pill!
y’all don’t be seeing the faces of these dudes on HIV meds, they be looking old and busted. hell to the no!!!
and I ain’t dating no HIV dude either, I rather date a unknown status dude, I can’t handle that shit!
not really feeling the tone of this comment, but I’m guessing it comes from a place of fear. The “look” you are referring to with regards to people on meds(who don’t need to be made to feel worse than they already do) is seen much less with the meds available today. Some facial wasting can be attributed to the virus itself in certain individuals, but as a whole, lipodystrophy(build up of fat)/lipoatrophy(loss of fat) are not as common as they used to be. As far as not being able to handle it, we are all at different stages of life and growth, but knowing more about HIV often helps. If you keep dating “unknown status dudes”, you might have to handle a partner with AIDS and not just HIV. Either way educating yourself a bit more on the subject would probably be a good idea.
Thanks for sharing the knoweledge
I am looking for friends but i am also heath conscios to,if i was with a black male,i would protect myself and have him protect himself,becase weare humans and we make mistakes too.
Very informative article!
I checked out the links on the blog post to learn more about the PrEP trials, thanks for the info. I had known about PeP, but you know I’m not really sure if it is available in Jamaica. I must find out.
I am going to forward this to my friends in NYC and Miami. We have to share knowledge with each other, you just never know who might need it when. Most of us have had a slip up with unprotected sex at one time or the other, so this info is needed.
Personally, I would have no problem dating a brother who was HIV+, but you know I used to live in England and the attitude there was very different. Most of us were well informed in my circle(even back then), so it was no big deal to have a relationship with someone positive, you just had to protect yourself.
I find a lot of my black men seem to be in denial about HIV and the statistics. How are you having sex all over Kingston, New York or Miami and think you haven’t dealt with a HIV+ brother? The ignorance and denial makes me laugh and cry at the same time.
If PrEP was available tomorrow, I wouldn’t start taking it because I’m not into casual sex at this point in my life. However, if I met my partner I would take it if he was positive, or maybe even if he was negative(until that trust is rock solid).
Look forward to more as usual
Wow, you asked a lot of questions there. I’ll answer the ones I think are the most important.
I personally don’t think I’d be up for PrEP. Mostly because I’m not consistent at all, and I’m sure you have to do it regularly or it won’t work. Also, I’m not all that sure about the side effects or the possibility developing dependence or resistant strains if one later infected. I’d need to see more research into that. The way proponents are marketing it is “a tiny inconvenience for you and a world of prevention on an individual and community scale.” It seems just as inconvenient (and far less expensive) for me to stick with the “use a condom every time” approach. I only have to worry about that a few times a year… once a week at the most.
Of course the cost is going to be prohibitive, but to everyone. I’ve actually had a conversation with prevention professionals in my city and they’ve said the number 1 reason they don’t heavily market PEP is because it is EXTREMELY expensive for the clinic, far more expensive than other prevention methods. I wouldn’t be surprised if extra money were doled out to better inform the black community. I doubt, however, that people are going to listen if there’s no extra funding for access to PrEP. It would be like testing in the 80′s when you knew you couldn’t do anything about it. Why bother.
This is already long so I’ll stop. I’ll end by saying that I’m a pretty creative person but there’s no way I’m altering my life to access this pill. To get health insurance, sure. But if I’m able to slip and forget about condom use, I’m surely going to slip and forget about my daily pill. For me, PEP is much more realistic than PrEP… and it’s already available.
ALSO, since this post seems to be just as much about sharing information as asking questions, I thought you might want to know about this site.
http://pep411.com/
It’s simple and features black people in their video and in their stories. Plus they make it really easy to share it with friends. Even though I’d been educated about PEP before, it’s one of the reasons that I feel confident asking about it now.
Thanks for the input Corey and please feel free to contribute here whenever you want to!
Wow….Interesting article and many interesting comments. One of the ones that got me was one guy saying he’s never sleeping with an HIV+ dude….um, trust me you have. As someone living with HIV and one who does disclose his status whenever meeting someone, I can tell you that for everyone who does disclose his status, there’s at least two who don’t. So before making such a blanket statement, I’m gonna tell you what I tell everyone and that is to assume anyone you meet is, unless you were there sitting next to them whem they took the last test, you really don’t know.
Now, onto PrEP…as someone who’s now on his second drug regiment due to becoming drug resistant to the first, I see this has taking a big risk as you could also build up a resistance for nothing and if you should become exposed, there’s nothing for you to take.