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As a person who has made the decision to take daily oral pre-exposure prophylaxis (PrEP) to protect myself from HIV infection, I understand the importance of this powerful prevention tool―and I think it could be beneficial to many more people at risk for HIV infection if there were broader knowledge and understanding about what it is and how it works. I now work in HIV prevention services, but before that I was among those unaware of the availability of PrEP. In fact, I only became aware of PrEP 3-4 years ago when a healthcare professional at work discussed it with me. Even people who have heard about PrEP may not completely understand what it is. I find that one of the concerns people have is that the drugs used for PrEP, such as emtricitabine (FTC)/tenofovir disoproxil fumarate (TDF) or FTC/tenofovir alafenamide (TAF), also are part of HIV regimens. This may cause some people to think that a person taking PrEP has HIV and is taking the regimen as a treatment instead of to prevent HIV. In addition, because PrEP is a pill taken daily, just like most HIV medications, it mimics taking medicine for HIV, and this similarity has caused some people to not want to take PrEP because of the stigma that still surrounds HIV infection. I also think that the people who do not know about PrEP probably include many of those who need it the most, because they may not be undergoing routine screenings where they would hear about PrEP.
My Decision to Use PrEP
When I was first considering PrEP, it was somewhat difficult, because I didn’t want to be labeled as having HIV when I didn’t and because I didn’t know as much about the virus as I do now. What would people say if they saw a bottle of FTC/TDF or FTC/TAF in my room? Their first thought would be, “He is HIV positive,” rather than, “He is taking PrEP.” Luckily, the people around me are generally aware of PrEP for HIV, so this has not been a problem for me, but I have heard stories about people having to explain their PrEP medications to others.
After I understood how PrEP works, how effective it is at preventing HIV, and what my risk of contracting HIV without PrEP was, the decision to take it was a lot easier to make. Five years ago, before I started taking PrEP, my risk of getting HIV was higher, as I was single and lived in Jackson, Mississippi, where HIV rates are high. Thus, my chance of contracting HIV was a lot greater than in many other places. Weighing that risk convinced me that PrEP was the right decision. When counseling others about considering PrEP, I like to ask an eye-opening question: Do you want to take a pill every day to prevent HIV or to take a pill every day to treat HIV? That helps to clarify the decision.
My Experience of Being on PrEP
Being on PrEP lessens the anxiety that occurs during HIV screenings. You are not sitting on pins and needles for 20 minutes waiting for a rapid test to come back negative, because you know that you have been taking PrEP as prescribed. If it works the way it should, you should be fine—and you should be negative. You may have another sexually transmitted disease, but you won’t have HIV.
I was new to a relationship when I started taking PrEP, and it was not a red flag for my partner, because my partner also had taken PrEP before. Because I did not have to convince him that this was PrEP and not an HIV medicine, we had an easier conversation. Regarding the adverse events of PrEP, I noticed that I could smell almost anything and everything for approximately 1.5 weeks after switching from one PrEP regimen to another, but I wasn’t sure if that had anything to do with the medicine. Other than that, I have not had any problems with PrEP.
Based on my experiences, I would highly recommend PrEP for people at risk for HIV infection. Regarding the frequency of follow-up testing and laboratory monitoring, I already was getting tested for HIV every 3 months as part of my routine, so adjusting to PrEP follow-up was easy for me. My clinic visits are straightforward and include laboratory tests, making sure I am still HIV negative, and having my PrEP prescription refilled if needed. After that first appointment, it was, “We’ll see you again in 3 months.” Because I was taking the medicine, there were no real issues to address. It was doing what it was supposed to do, and I have remained HIV negative.
Could PrEP Be Improved?
Currently available daily oral PrEP works very well for me. However, I would prefer a longer-acting option that I could take less frequently, such as some of the options being evaluated in clinical trials—injectable or oral options that are taken either every month or every several months. A small PrEP implant that lasted for 1 year would be the ideal option. Although many people already take medicine every day—for example for high blood pressure or allergies—I struggled with taking PrEP every day in the beginning. I am excited that other less-frequent dosing strategies are being developed. Having more options will allow each person to select a method of HIV prevention that works best for them.
As a person who takes PrEP and an advocate for HIV prevention services, I would love to see more people on PrEP. As a start, it would be great to see more people even just ask about PrEP, because it is a lifesaver. Everyone who wants and needs it should know about it and be able to access it.
What do you think is the biggest barrier to PrEP use in your community? Join the discussion by posting a comment.