Tantamount to any decision that I make in my life is to be in full awareness of who I am, what I am experiencing, and what potential information may emerge from whatever actions I choose to take. I always seek to enhance my experience in life moving forward.
For me, choosing to undertake PrEP treatment ultimately was a decision that has led me to learn more about myself, about my body, about my sexual, spiritual, and emotional health, and about my relationship with others in the same. It has given me unexpected knowledge and observations about the world I live in, and the strength to stand in my power despite the ill intentions, misgivings, and judgments of others.
So when I was asked to write about my own experience with PrEP, I realized that there was potential to help others. I realized that sharing my story would help others on their own life journeys, particularly if they are considering undertaking the same treatment in their own lives. I share what I share in this essay without judgment or expectation, without any desire to influence you, the reader, in one way, or another. I simply want you to benefit from my own journey, in whatever ways it is possible as you decide how to make your own choices in your sexual health.
As a single, sexually-active Latino male in the United States who predominantly, but not exclusively, has sex with men, and who fosters and guides and counsels others on a path of celebrating embodiment and conscious, sacred sexuality, I feel it is important to tell my own story, in as open and as authentic way as possible.
What is PrEP?
PrEP, or Pre-exposure Prophylaxis, is a proactive, scientifically-proven way to help significantly limit an individual’s exposure to HIV-1, the human immunodeficiency virus. The treatment, which involves taking a single dosage (one pill a day) of emtricitabine and tenofovir disoproxil fumarate, better known by its brand name of Truvada, helps to protect an individual from acquiring HIV-1 by inhibiting the reproduction of the virus in the bloodstream.
The treatment program has minimal side effects. In the United States, the process for taking PrEP requires regular doctor visits for blood checks, screenings for HIV and other sexually transmitted diseases, and regular monitoring. And the medication requires adhering to the daily dosage to remain effective.
You can find out more about PrEP and Truvada specifically by visiting their website.
For me, the journey of getting to the point of deciding to make PrEP as fundamental part of my sexual health was not easy. The journey since I began has been very empowering, but it has not been without its challenges.
The journey begins: Facing resistance
When I first heard of PrEP, I was most clearly opposed to considering the treatment. There were several reasons for this rejection. I found I was experiencing great concerns because it meant that I would be taking medication to prevent HIV infection. Few of these reasons were logical, but they were fundamental to my experience.
The first was recognizing that taking medication to prevent HIV was an act that would force me to confront that I am sexually active. This resistance was about sexual shaming. Now, people find this silly, because a man in his 40s should have no issue claiming to be sexually active, but there it was. I have been sexually active since my early twenties, and I grew up closeted in a very conservative West Texas community. Until recently, I had never embraced my sexual expression as natural and healthy; it was always grounded in stigma and internalized homophobia. So taking a pill was a radical statement — one of the most radical I had thus far experienced.
The second reason I was struggling with deciding to take PrEP relates to my sexual behavior up until that time. Compared to heterosexuals, sexual minorities often experience considerable challenges in establishing healthy sexual identities and behaviors. Unfortunately, for me, I struggled to even confront my sexual orientation and attractions until my mid-twenties, and I continue to work on acceptance even today. Up until my mid-twenties, I was suffering from depression brought on by internalized homophobia. I experienced suicidal ideation regularly. The beginning of my sexual experiences was paired with excessive alcohol consumption that led to alcoholism. Using substances to alter your sexual experiences often minimize your opportunities to practice self-care. That self-care includes making better choices about sexual interactions.
The third reason I struggled with deciding to take PrEP revolved around making choices to avoid taking medications and non-natural substances into my body. At the time I began exploring PrEP as an option, the idea of taking anything that was not natural was not appealing to me. As I’ve grown older, I’ve become naturally more resistant to pharmaceutical options and the medical establishment in general, but I still resist becoming almost wholly dependent on taking daily doses of mountains of pills and many visits to medical providers to stay healthy. I was, and still continue, to explore homeopathic options for health conditions. But the idea of taking a daily pill of a chemical concoction was disconcerting.
Another reason for my resistance was grounded squarely in my understanding, and lack of understanding, of HIV and AIDS. The AIDS epidemic emerged simultaneously to my own sexual awakening as a teenager. Lacking any support to help me sort out my feelings about my emerging needs and desires, I was alone in this journey. Sitting in school classrooms listening to boys talk about how they would “kill the faggots” and sitting in church hearing about how men who lay with other men would be condemned to eternal damnation did not help with my psychological well-being. Pairing these experiences with coming home to watching nightly news updates of gay men dying of a horrific unknown disease linked to their sexual behavior left me feeling condemned to live a life I did not want to live. In the context of all of this, taking a daily pill to prevent HIV would be a profound political statement — one I was not sure I was ready to make, after 20-plus years of struggling with finding ways to practice self-love and acceptance.
Ultimately, it took almost a year from finding out about PrEP as an option before I committed to beginning treatment.
The journey to PrEP was not easy
Once I was committed to going on to PrEP, I was already in a place of feeling more comfortable about my sexuality and my sexual health. I had proactively sought HIV testing and sexually transmitted infection (STI) testing at least annually and was progressively moving towards finding medical providers that I could speak to openly about my sexual orientation and behaviors.
Going on PrEP would be easy. Or so I assumed.
Once I had done my research, I found that many providers still lack knowledge of the treatment, or, even more disturbing, they either discourage or actively refuse to allow access to patients for the treatment. Even today as an individual who helps patients to access sexual health support, I find that most providers working in medical establishments do not know, nor do they understand, what the treatment is. Many also allow bias to interrupt their process of understanding.
For my part, I ended up finding a gay-friendly provider to attempt to access treatment. Unfortunately, he was not yet aware as the treatment, so I ended up educating him about its availability. He was supportive and respectful, but it took him some time to catch up on the treatment. Although I have become savvier about seeking out providers, I still confront stigma, lack of knowledge, and basic irresponsibility around PrEP from medical providers.
What it’s like now
I have now been on PrEP for more than three years, and in fact, now I actively help others to access treatment. Although generally, access has improved, we still have quite a way to go. It is not uncommon to hear stories of individuals encountering barriers in hospital emergency rooms, providers offices, or even at pharmacies. For some patients who have up until the “PrEP talk” had effective, supportive relationships with their providers, discussion about the treatment can be a non-starter, leaving patients alone to find someone else they trust to access treatment.
Despite these kinds of barriers, for me, the journey has been worth it.
I have found I experienced many intended and unintended benefits after beginning treatment. First, and perhaps foremost, I have gained agency. For the first time, I feel fully in control of my sexual health. I have confidence in understanding and making my choices, and with this confidence comes considerable freedom. As part of treatment, I am tested for HIV and STIs frequently, so I am continuously familiar with where I am in my sexual health. I no longer sit in fear worrying about “what if.” And, parallel to this, I’ve learned much about how to expand ways I interact sexually with others, to reduce the risk of HIV and STIs. I now know many more options for connecting intimately with others that either reduce or completely eliminate risk.
The daily ritual of taking a simple blue pill a day has had some unintended positive results as well. As a guide who helps others learn more about sacred sexuality and the power of integrating spirituality and sexuality, ritual is a powerful practice in my practice. For me, taking a pill once a day to help protect me against HIV was a “mini-meditation” about my desire to care for my body in sexual health matters. That daily ritual has had profound effects by empowering me to stand more fully and completely in my sexual expression and identity. That, for me, has been one of the most profound gifts of all.
Choosing to go on PrEP
To those individuals who choose to go on PrEP, I have some things to share based on my own experience.
Advocate vigorously for your own sexual health.
Congratulations on making a vitally important decision —it shows that you are actively working to take care of your sexual health through your conscious decisions. Evaluating PrEP as a regimen to your life experience is deeply personal, and everyone’s choice should be honored and respected.
Beyond the obvious medical benefits of having an additional layer of defense against the potential for HIV infection, research is beginning to emerge the shows there are psychological benefits to PrEP treatment as well. For many who lived through any aspects of the emergence of HIV in the 1980s, trauma and fear based on the possibility of infection has affected their sexual life experience. Starting PrEP often helps men to either lessen or eliminate fears or anxiety related to HIV and AIDS.
When it comes to your body, YOU are the expert
Recognize that you probably are more informed than most people, and more informed than many healthcare providers, about your sexual body. Some people don’t understand what you are doing, so it falls upon you to educate them. There are no guarantees that you will not be judged for your decision, but you are likely to be judged regardless of what decisions you make about your sexuality.
Do not automatically assume direction or guidance you receive from a medical provider is accurate, complete, or correct. Ask questions. Ask for clarification. Get additional opinions. You have a right, and arguably, a responsibility, to fair, accurate, and non-judgmental information and advice about your sexual health matters.
People will be judgmental, so stand your ground
Recognize also that there may be other biases at work as well. If you are female or trans, if you are gay or bisexual, if you are polyamorous, if you are Black, Hispanic, or other person of color, if you are a sex worker, if you have economic limitations, or if you have a disability, the risk increases significantly that others, including health care providers, will not be listening (not hearing) to you, or may allow their own expectations or prejudices to affect the information, guidance, or support they provide you in your sexual health.
So be assertive, even aggressive, about what you know about your sexual body. Ultimately you are the first and only line of defense against bad decisions as they affect your body.
Remember that you are always ultimately empowered to make your own decisions. Whether you choose to engage in PrEP, learn more about HIV and STI risk reduction strategies, or just explore your options, member that any steps you take can make a significant difference in your life.
I wish you a wonderful journey in embracing your right to your sexual freedom and health.