In May of 2014, the first comprehensive guidelines for PrEP was introduced to the public. PrEP stands for Pre-exposure Prophylaxis and is described as a powerful HIV prevention tool. In a nutshell, those who are at the highest risk of becoming HIV infected can take a pill once a day. Truvada is a combination of tenofovir and emtricitabine, which has shown to reduce the risk of HIV infection. I have read and educated myself on the potential benefits. The clinical guidelines for PrEp are very specific. For instance, I am HIV positive who has a partner that is not. According to their established clinical guidelines, my partner should be proactive and be on PrEp, and we both agree this is crap. There are many risks that cannot be evaluated as part of any clinical trial and that is human behavior.
I witnessed firsthand the decimation that HIV wrought upon us during the 80s. The next decade brought in a reserved celebration as potent new drug cocktails came out, seeing those individuals living with HIV lead as normal a life as they could. Although the drug cocktail regimen brought many promising new treatment options to those who had been suffering for many years, it also ushered in a time of complacency and a false sense of security, because HIV was no longer seen as the “death sentence” it once was, but a disease that is chronic and treatable much like diabetes. Like the drug cocktails that brought complacency with the older generation and a false sense of security to the younger generation, it’s now PReP turn. Human behavior is difficult to predict and sometimes the desired result or expectation becomes an unintended consequence.
Human behavior is difficult to predict, and in the LGBTQIA+ community, trying to predict our behavior nearly impossible. I never could have predicted 25 years ago that there would be bug chasers today (Bug chasers is defined as those who are SEEKING to become infected with HIV). To those in my generation, we find it deplorable that individuals today are looking to become infected, but for many in the younger generation it is not uncommon for someone to know somebody who identifies themselves as a bug chaser. Obviously, these individuals may be mentally ill but provide an interesting snapshot of how the different generations view HIV. Will the bug chasers of today be replaced by the Truvada addicts of tomorrow?
Quickly, I am reminded of my own HIV infection and my main argument opposing PrEP: the possibility of HIV mutant strains. Although I am healthy and am currently on HAART, I am unable to take NNRTI’s, because the individual who infected me took NNRTI’s, stopped treatment and started again, repeating a cycle that would see his virus resistant to NNRTI’s, a resistance that passed to me, limiting my treatment options. In theory, this is very possible and provides enough evidence to me, based on my personal experiences and those of others. Do we risk stifling future HIV medical treatments, because we have to backtrack and find ways to fight multi-resistant strains of HIV?
During this time, while advances in medicine were taking place, so was technological advances. These advances in technology have made dating much different than it was just a decade ago. In the decades I grew up in, a simple sex encounter or hook-up could prove fatal. For many, HIV scared enough of us to practice safe sex or completely abstain from sex, but today that is not the case, with apps like Grindr, Scruff, and Jack’d, the sex comes to you.
We are reckless in our behaviors, particularly when it comes to sexual encounters, and the internet has made our reckless behaviors much easier. We can hide behind our computer screens and pretend to be something we are not, lie about who we are, and continue to think you know everything there is to know about someone For many, PrEP will be just another excuse to continue their reckless behavior, where the bug chasers of today are the Truvada addicts of tomorrow. The desired result sometimes brings unintended consequences and PrEP will prove to be a setback that will cost us years in the fight against HIV.