PrEP For HIV Prevention

As part of an ongoing series of videos on health in human pup play I had the pleasure of sitting with Pup Beacon and talking all things PrEP: Pre Exposure Prophylaxis, an exciting technology that can help reduce the risk of HIV infection when taken every day.

Currently the key criteria suggested for people to consider PrEP include:

  • Being in a serodiscordant relationship: that is a relationship where one partner has HIV infection and the other person does not.
  • Any recent STI’s (sexually transmitted infections) within the past six months
  • Any history of inconsistent use of condoms as a means of HIV prevention
  • Feeling at risk of HIV and an open desire to start PrEP

If you would like to learn more about PrEP I recommend the following websites as great resources:

http://www.cdc.gov/hiv/risk/prep/
http://www.whatisprep.org/
https://start.truvada.com/

Transcript:

Pup Beacon: Sure. My name is Pup Beacon and I live in Long Beach, just outside of Los Angeles. Originally from Northern California but I’ve been living down here for about 10 years now.

Gpup: Okay. I came to see quite a few of your posts on Facebook.

Pup Beacon: Okay.

Gpup: Because you were quite open about being on PrEP, how long have you been on PrEP?

Pup Beacon: I’ve been on PrEP for two and a half years this month.

Gpup: How have you found it?

Pup Beacon: It’s been absolutely amazing. There’s a lot of fear behind HIV and having an intimate interaction and encounter with another individual or individuals and being on PrEP has all but eliminated that fear, at least for me. I know for others the fear persists and there’s others that there’s no fear whatsoever. For me, I’m aware that it’s not one hundred percent perfect, but it’s pretty darn close.

It’s been an amazing experience. It’s been very liberating for me and I’ve been able to be free during sex and be in the moment. When you are constantly in fear of HIV and if you’re are thinking whoever you are playing with, if you are thinking that you could get HIV from them they become an advisory in a way. They become the bad guy in a sexual encounter, which you really don’t want to have that kind of negative emotion and negative head space when you’re having sex with someone. If you don’t look at them that way and you think that you’re protective, because of PrEP all of those feelings and emotions and that head space goes away and you are able to just be in the moment. Be present and enjoy that interaction that you are having at that moment.

Gpup: It’s interesting of wording that you use, because within S&M we talk about consent right?

Pup Beacon: Right.

Gpup: The idea that if you’ve negotiate throughout the scene then you can throw yourself into the scene and really really enjoy it.

Pup Beacon: Right.

Gpup: I see that there’s a parallel there with PrEP, because you’ve already negotiated this safety, because you’re in control. So you’ve found that it’s sort of sexually liberating to to take that one big elephant in the room and to say, “we don’t have to worry about it.”

Pup Beacon: When it comes to my self? When it comes to two partner to clear a physical situation, “I being one of them.” I know that I’m protected. I know that I’m set, I know that I’m solid. The other individual that I’m playing with ideal I would of had some form of a conversation about what their status is, how often do they get check, so on and so forth. There are of course times where you don’t have that conversation, but especially in those times when you don’t have that conversation I already know I’m protected so I feel good about that encounter. I feel much more comfortable, much more at ease and I can enjoy what’s going on, because I’ve already had that negotiation with myself.

Gpup: Within Australia, I’ve also been on PrEP for probably about two and a half year. I prescribe PrEP for people as well, but I’ve also been able to experience that shift of where I don’t feel stressed around HIV.

A lot of people will go on to PrEP, because of extreme fear of HIV, despite the fact that they may not have particular risk factors, but for me I think anything that is going to help people feel comfortable with sex is going to be a good thing.

Pup Beacon: I think especially as gay men, we bring enough bagging into the bedroom. If we’re able to eliminate that particularly large piece of luggage that’s going to do wonders for us.

Gpup: How did PrEP show up on your radar?

Pup Beacon: It primarily showed up my radar based on … Before I started I was in close relationships with a couple of different men that told me that they were positive. I wanted to continue having close relationships with those individuals and I wanted to figure out how can I make sure I’m comfortable and make sure I’m protected. Before I started on PrEP, I was as unaware as HIV and transmission as anywhere as anyone gets. Before, I started on PrEP I wouldn’t even have sex with someone who had sex with someone that was positive.

I wanted to have sex with person A and they had sex with person B who was positive, even if they were undetectable I still wanted to have sex with person A. That was back then. I’ve come a long way, but that was my starting point. When those two individuals told me that they were positive that really threw me for a loop and I really needed to get educated and become an adult and actually know how to take care of myself and take care of my body and frankly take care of those partners as well. Though those discussions I learned about PrEP and it just seems like an amazing tool to be able to protect myself from HIV and not only protect myself, but the individuals that I wanted to play with that were positive. They felt better about playing with me, because they new that I was protected. They knew that I was safe. They didn’t have to worry about transmitting anything on their own.

Gpup: There is a group of people living with HIV that will not have sex with people who are negative. I can understand why. There is a lot of stigma around HIV.

Pup Beacon: Sure.

Gpup: My hope that PrEP will change and has changed that.

Pup Beacon: I think that not only PrEP but more education and more awareness about through treatment for individuals that have HIV. It was the partner study that came out a couple years a go that showed that for couples that one partner was positive and the other was negative they positive partner didn’t transmit HIV to the negative partner. If I recall right, the individuals in that study tried numerous combinations of topping, bottom with it, with a condom, without a condom, but still they didn’t transmit, just because the HIV medication these days is so good that you’re not going to get HIV from someone who is undetectable.

Even still, there are individuals that take a lot of responsibility for their own health and they don’t want to effect someone else’s health based on their current situation.

Gpup: Another aspect that the partner’s study did also high light that will have sex with multiple people, right?

Pup Beacon: Right?

There were zero conversions within the partner study, but when they looked at the virus it was a different virus from their partners. Which just goes to show that we are sexual beings and that we can control our own status with something like PrEP.

Was it an easy process? What’s it like to get on PrEP here in the states?

Gpup: I got on PrEP through two different methods. Initially when I got on PrEP it was through a study on PrEP. It was a behavioral study, specifically looking at young men, young black men who had sex with other men. The study was funded by UCLA, local university, et cetera, et cetera their health program, so I was able to get the medication through that study. You come in every couple of months. Get tested. Answer a couple of questions about your sexual habits and so forth. That’s one particular route to get on PrEP if you wanted too.

After that year study was over, I went to my primary care physician, at the time with Kaiser and I was able to get on PrEP pretty quickly. Partially because I was already on PrEP, so when I talked to my doctor it was a conversation of, “This is a medication I’m already taking. I just want to continue taking it,” so it wasn’t that difficult of a conversation. In addition to that, my leather family at the time, my Dom had the same physician that I had. He already had the PrEP conversation with his physician, so by the time that I came around and knew the same physician it was no problem at all getting on PrEP. Kaiser in LA has a really strong PrEP program. They have individual physicians that all they handle is PrEP. There are different health care networks that are more aware about PrEP. There are certainly some that are less aware. Everyday I see on Facebook or somewhere else that some physician didn’t want to write a prescription for PrEP, because they didn’t know about it.

Frankly, my personal opinion they are to lazy to find out about it and they weren’t really caring about that individuals health, just because they didn’t want to look into that information.

Pup Beacon: Is it west Hollywood that was saying they were going to fund PrEP for whoever wanted to go on it?

Gpup: That I don’t know off the top of my head. I do know there are a number of cities, Seattle for example if you want to get on PrEP in Seattle you are good to go. There is no hassle, there is no barriers you can get on PrEP. There are certain cities like that, that are becoming more aware about PrEP on a government level. I know that LA does have a strong awareness about PrEP and they are pushing it, but there is also opposition from a certain health organization in LA that will go unnamed for the purpose of I don’t want them coming after me.

Pup Beacon: That was the next point that I was going to talk about. That LA does also have a fairly strong anti-PrEP lobby group.

Gpup: Yes.

Pup Beacon: What’s it like for you gay men in LA, in a city that has two opposing view points on PrEP?

Gpup: I think that frankly for the group that does strongly lobby anti-PrEP. They have a lot of money. They have a lot of pull. They’ve been doing the, “ye who shall not be named.” They have been doing a lot of work in the community for decades. They have a lot of pull. They have a lot sway and it does take a lot of work to fight such a large force. Thankfully, there are a lot of smaller health care organizations. You have the Gay and Lesbian Center both in LA and I believe the center in Long Beach advocates for PrEP. I know the folks in LA do, not only advocate for PrEP, but if you wanted to get on PrEP you can go to the center and they’ll take care of you. There is definitely those two voices when it comes to PrEP.

What is important to me and what I find is the most important part of this conversation is just education. When it comes to education and STI’s in general, education, education, education. The more we’re educated, the more we’re able to have an open discussion about these topics and the more we’re able to protect ourselves. If the discussion about PrEP doesn’t end at that particular lobby. If someone says, “I heard so and so says this about PrEP,” and that’s the end of the conversation then we’re not going to get anywhere, but if we’re about to say, “So and so says this about PrEP, is that true or is there any other information that I need to get?” That’s what’s important we need to make sure that that information that’s getting out is also getting rebutted.

Pup Beacon: One of the more, I suppose concerning figures that’s out within the American [inaudible 00:13:14] from my understanding is the largest population of zero converting men in American is within African American [inaudible 00:13:22]. What has PrEP pick up been like within … Do you have a circle of friends that are African American?

Gpup: Sure.

Pup Beacon: There’s actually a couple points. I just had this conversation with some other folks and we were talking about it in depth. A couple of weeks ago, I went to a PrEP summit that was hosted by the Black AIDS Institute and so the entire day … I was literally an entire day from about 8 A.M to 4 P.M was just topics specifically talking about HIV and PrEP within the black community. What are the conversions rates? What is the out reach that’s being done? How can we reach more people? What are the oppositions? What are people’s feelings towards PrEP and HIV in general, so on and so forth.

My personal feelings when you look at maps of the zero conversions for PrEP or for HIV rather. They happen a lot in the South. They are heavily concentrated in the South. When you look at those states and if you look at other types of maps, like teen pregnancy rates and STD transmission rates it’s pretty much the same grouping of states. It’s the same geographic area.

If you have an entire area that is completely so far behind when it comes to sex education that tells me that it’s not necessarily a racial issue it’s just a geographic issue. You have to look deeper then just race. You have to look at the politics in that particular region. Teen pregnancy rates are high in that particular region, not just among black individuals, but white, everyone. In my personal opinion what that tells me is that there is a huge lacking. The education about sex. The education about transmission. What that tells me is we need even more funding going to that area. We need more Planned Parenthood centers et cetera, et cetera. That’s how I look at that particular issue, because if you look at the map of transmission rates and other parts of the country, even broken down by race it doesn’t mesh that it does in the South.

Gpup: Within Australia, PrEPs expensive. Within America, PrEPs expensive. [inaudible 00:16:00] cost $600 a bottle in Australia. I’ve had people here in America tell me that they are paying more then that up to 1200 for a bottle of [inaudible 00:16:08]. Which it almost as if it was a luxury item. Is that part of the reasoning if people in the South have a higher rate, is it more to do with Economics then it is to do with anything else.

Pup Beacon: Again, I go back to my point on education that education is so important, because while the sticker price for Truvida can be $1200, $1500 whatever that’s not actually what the average person pays. My copay has been anywhere as low as $15 up to $50 depending on the insurance that I’ve had at the time. If you have insurance even through Obamacare, The Affordable Care Act, which is a thing in the states that allows more people access to health care. Even on that, when I was on The Affordable Car Act I was only paying $30 a month for my Truvida. That’s something that’s granted access to everyone. If you are on Medical or Medicade, the medication is just free. If you are on that health care plan you have access to it. If you aren’t on ACA or Obamacare or MediCal or MediCade and if you don’t’ have insurance through your employer and you are just completely uninsured Gilead the manufacture of Truvida still provides assistance to get access to the drug.

Like we said, cities like Seattle they still provide the drug regardless of whatever your insurance situation is. When it comes to parts of the South, it could be just an issue of education. They need to know that they actually do have access. Going back to Gilead. They also provide a copay assistance. Even if you do have a copay you can still get hundreds of dollars. I can’t remember what the exact dollar amount is, but it’s hundreds of dollars towards the copy. If your copay is $50 you contact them and you can get it for free.

Gpup: That’s getting the drug in the hands of the people who are willing and ready to go on the drug.

Pup Beacon: That’s the thing, “willing and ready.” They need to be educated to be able to be willing and ready. Education is the number one term.

Gpup: In Australia today is an exciting day, because PrEP was just FDA approved.

Pup Beacon: That’s awesome.

Gpup: The next step is can we convince the government to contribute to the cost of the Truvida.

Pup Beacon: Right.

Gpup: There’s study happening right now to do that. If you had a friend who came to you and look, “I really want to consider this and I want to get started.” What advise would you recommend to them?

Pup Beacon: First I’d say, “Yay! Awesome!” In terms of advise, I’d ask questions about what is their health care situation, what is their insurance situation, do they have insurance who is their provider. If they have Kaiser it’s super easy. Kaiser has their own dedicated staff specifically targeting PrEP, so if you are on Kaiser it’s super easy. If you have any other form of health care insurance just find out what the copy is. It’s typically categorized as brand medication, so every insurance has their own classification of how much that costs. That’s the cost issue.

When it comes to getting on prep, go to your doctor and what I would recommend is the CDC has a fact sheet, just a PDF fact sheet that you can download print off and take to your doctor. It’s got not only information that the layman can read, but also physician specific information. You can give it to them and say read this, this is what I want to take control of my own sexually health. I want to make sure that I don’t get HIV. I know that this is a tool that can allow me to prevent that from happening and I would like to utilize that tool. If they have the information then odds are it should be smooth sailing. Sometimes you might have to get transferred over to an infectious disease specialties, but again you can just provide the same information to them and it should be good to go.

Gpup: So, family physicians here in the States are able to prescribe PrEP as well?

Pup Beacon: I’m not sure about the different classifications of physicians. I know for myself I have Kaiser and so my primary care physician just sent me off the PrEP department. I’ve seen situations where they don’t need to get an infectious disease specialist involved, but sometimes they do. I think it just depends on the doctor and what they are comfortable with.

Gpup: The other thing is that starting PrEP can be tricky and I think that starting PrEP for anybody is the key point where you want to get it right and there is no harm in having an expert in the room at the same time. Right?

Pup Beacon: I’ve talked to a couple of guys where they’ve been a little bit scared of talking to an infectious disease specialist just because they feel like if they have to talk to that person then there is something wrong with them. It’s totally okay to talk to someone who is a specialist in something. In the Kink World, if you are going to get Single Tailed to you want to get Single Tailed by someone that’s an expert or someone who know idea what the hell they are doing.

There are times when it’s okay and it’s ideal to talk to someone that’s a specialist and knows what the hell they are doing.

Gpup: You got to see the dude with all the books on the shelf.

Pup Beacon: Exactly. They are there for a reason.

Gpup: What a fascinating conversation. Thank you so much.

Pup Beacon: You’re welcome.

Gpup: If someone wanted to contact you about PrEP … If you are willing what’s the easiest way for them to contact you?

Pup Beacon: I’m Pup Beacon on Facebook, also on Reacon, also on FetLife and assorted other usernames on other sites. Facebook is typically the easiest.

Gpup: Fantastic. Thank you very much.

Pup Beacon: You’re welcome.

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