All About PrEP for HIV Prevention

Okay, it seems like you’ve met the right person. They are lovely, kind, generous, gorgeous, and funny. You can't help but to tell your friends about them. There is something genuine in them that you admire. They really do show you love when you least expect it. You care for them. [forumDriver id=13863] The intimacy is off the hook as well, both in and out of bed. They’ve told you they are living with HIV and everything is great. They take their medications every day and you may be taking PrEP too in support of your relationship. What is a mixed-status couple? This type of relationship has a fancy title in HIV prevention circles. It is called serodiscordant. Serodiscordant couples, or mixed-status couples, are ones in which one partner has HIV and the other does not. Couples in these relationships have three unique tools for them as they grow their relationship. The HIV positive partner on antiretroviral therapies, the HIV negative partner on PrEP, and condoms are a powerful trifecta of prevention. Helpful tools Effective HIV treatment with antiretroviral therapy These three things are powerful because, first off, HIV positive people on antiretroviral therapies have very little virus circulating in the blood. They have such a low amount of virus that they are virtually undetectable and pose a very low risk of passing on the virus. However, one needs to be consistent in their regimen and regularly getting care from health providers. So in this case, effective HIV treatment is prevention. Remember, undetectable = untransmittable. [poll nexus_id=13859] Taking and adhering to PrEP The second tool is PrEP. Right now, Truvada is the most widely used drug for PrEP, although other drugs have been approved by the FDA and might soon be available to consumers. PrEP is an amazing tool that, when taken daily, can reduce the risk of transmission by about 99% according to the CDC.1 However, just like antiretroviral therapy, the effectiveness of the treatment corresponds directly with adherence to the daily regimen. [poll nexus_id=10379] Using condoms The third tool is condom use. Now to cover all the bases including STIs, condom use is still the only method to prevent other viral and bacterial infections from being transmitted during sex. This is why it is still so important to see a healthcare provider or go to the clinic at least once a year to get tested. Maybe this could be the day to walk into the clinic hand-in-hand and recommit to each other’s health by getting tested together. Then go out to dinner, and end with a romantic evening at home with your partner. Tools for intimacy and dating The tools at our disposal are powerful and allow for healthy people to develop close relationships regardless of HIV status. It will still take time to educate the broader public. However, whether you are HIV positive or negative, we all need love and intimacy in this life. Let’s continue to remember the tools we have at our disposal and continue to live! Do you and your partner have stories to share about being a mixed-status couple? Let me know below. [lead_gen showIfLoggedIn="0" campaign="shortcode_posts" source="site"] The first time I heard of PrEP was five or six years ago. I remember looking online for science research studies to join because I was broke and had some real bills to pay. I happened to come across the Ruth R. Rothstein CORE Center in Chicago, Illinois. What was so great about this place is that it is entirely dedicated to servicing adolescents and adults who are at risk and living with HIV. It has everything from a testing clinic, pharmacy, outpatient care, dental services, and a research center. PrEP for HIV prevention When I first walked in, I was greeted by a young study coordinator, Pedro. He walked me through what PrEP was and what it wasn’t. Explained to me simply what the effects of PrEP are and how the study was looking at web-based tools to keep people taking the pills on a regular basis. My immediate reaction was like ‘This is birth control of HIV.’ Taking PrEP requires commitment It really was, and I found out how hard it can be to take every day. Everyone has a different way of moving through sexual relationships and romantic encounters and, for me, my tendency for engaging in sexual behavior could be described as ‘seasonal’. Winter is usually a dry or a cuffing season when I would more than likely be with a stable partner. The summer would be a time to be free as a butterfly. But PrEP requires some commitment to taking it regularly. My provider told me PrEP works really really well when taken every day. If you take it 7 days a week, you’ll more than likely experience a high rate of protection. But the more inconsistent you are, the more likely that that protection will decrease. Additional benefits of using PrEP We’re human though and, through these first encounters with PrEP, I realized a few benefits outside of just the medical benefit of taking the medication. PrEP requires you see a physician every 3 months to get a renewal. Talking to a medical professional about sexual health is absolutely one of the best benefits. At first, it was awkward. Sex is a very personal thing, but over time I developed real relationships with the doctors and nurses. I felt like they listen and gave great life advice as well as medical service. A welcoming space for PrEP and HIV services From the first encounter at CORE center, I felt welcomed and treated with dignity and respect. As an advocate, I hope you find a community of health professionals to guide you on your journey through PrEP and HIV services and in my first few posts, I would like to spotlight a few individuals at the Ruth R. Rothstein CORE Center in Chicago. All good things fam! JT [lead_gen showIfLoggedIn="0" campaign="shortcode_posts" source="site"],If you’ve been following my PrEP journey, you might want to know a little more about me. My name is JT and I am a proud Black musician from the south side of Chicago. I have had many careers from library security officer to lab scientist to a freelance writer. I consider my music-making to be a vocation. Music means so much to me now more than ever. It is the thing that runs through most moments in my life. My community is very important to me. And I am a PrEP advocate. What sex and intimacy mean to me From childhood, I always had a curiosity and a sense of the beauty for people. Every individual person is so unique and special to me. My idea of beauty and love is very particular and I always know it when I see it. It's not just one's looks or intelligence. Beauty has to do with what one does with their whole being to express love and compassion for other people. Now I know that is a grand notion of beauty, but it's simply a feeling that someone gives off. Sex should be fun Art and sex are some of my most intimate moments and through both, I am able to communicate expressions of love. Sex for me is a moment to give and receive love. I really want to put a smile on their face. I want to explore as much as is mutually satisfying. I want to have fun. Sex should be most of all fun; otherwise, I don’t think I would do it. My experience with PrEP for HIV prevention PrEP is a tool that allows me to be accountable to my partners and myself. In all my medical experiences, PrEP has been the most unique ‘accident’. Not only does it allow me to be accountable, it helps me develop a meaningful relationship with my healthcare provider. Going to a doctor's office every three months is a chance to really open up to this stranger that is my doctor. A better understanding of my overall health I have a better understanding of my overall health too. The screenings brought attention to my tendency to carry extra weight and also my slightly elevated blood pressure. If I wasn’t already going in for my PrEP appointment I would have never known I was at risk for these additional chronic conditions. Learning about myself while taking PrEP In my life, I truly strive for a balance of my mind, body, and spirit. On this journey, I am realizing the ups and downs of taking medications every day. I have also learned so much about myself and what my personal values are when it comes to sex. Through these experiences, I am constantly forming opinions on what I like and don’t like, and with it is the eventual settling into who I’ll be for the rest of my life. I am grateful for this journey so far and, with or without PrEP, I think it serves a meaningful purpose in helping people express themselves and find out what they value in a potential partner. Be well and comment below. [lead_gen showIfLoggedIn="0" campaign="shortcode_posts" source="site"] It may be hard to believe that I'm sex-positive because I'm HIV positive when the vast majority of us believe HIV is the end of our sex life. But, it's only the beginning of ultimately owning our sexual selves. Am I undeserving of sex? I was born with HIV so, from the very start, my sex life was deemed over since birth; that's pretty cruel toward a child that hasn't experienced our sex culture yet. Being HIV positive, people see me as a threat and endangerment toward others. Therefore, people believe that I should opt out of engaging in sexual activity to give them peace of mind. I can't opt out of being human The problem with that statement is that those people are only thinking about themselves and are not thinking about people like me. To believe I'm undeserving of having sex reveals their lack of awareness that we are naturally sexual beings, and I can't opt out of an experience that is included in the needs of humans. Sexual expression is as vital as any other form of self-expression we have, and oppressing our feelings causes harm to our overall wellness. Attacks on my sexual self didn't make sense What helped me dismiss the belief that my sex life was over was that my sex life never began; the attacks on my sexual self simply didn't make sense. Shaming and criminalizing sexual behavior One type of attack that didn't make sense (since I was born HIV positive) was trying to condition me to believe that people would shame me for my previous sexual behaviors and potentially criminalize me for having sex while being HIV positive. This attack is invalid because we can't assume that people living with HIV intentionally want to give others HIV, nor is it reasonable to connect someone's sexual behavior to their HIV diagnosis. Fear of children being born with HIV Another type of attack was implanting fear that my children would be HIV positive. But that didn't make sense because my younger brothers don't have HIV. These attacks reveal that the HIV narrative is flawed, and it is intended to be that way. Our cultural views on HIV aren't about informing people about HIV; it's about oppressing people's sexual selves. Society's views on sex and STDs We live in a society that expects us to be in a monogamous relationship; anything outside is looked down upon. Sexually transmitted illnesses are associated with people who engage in sexual activity that isn't monogamous. In reality, certain STDs are transmitted non-sexually, especially through skin-to-skin contact. But, this isn't well known among the citizens of our society. Our culture intentionally misinforms us about STDs so that we can continually oppress ourselves and others sexually. The truth is that STDs are a part of life, just like any other health condition. Therefore, instead of dismissing this reality, our culture should unite people by empowering them to care for their sexual health. Since I have acknowledged that our exposure to sex is oppressive, I choose to opt-out and empower myself and others to be their sexual selves. Being HIV positive has made me sex-positive Being born HIV positive has made me sex-positive because I understand what it feels like to be invalidated, dismissed, and fearful. I have no desire to make others feel that way about their sexual expression. It's important to acknowledge that we are all oppressed sexually; I just happened to recognize sooner because I was deemed unworthy of having sex from the start of my life. So, I had to find the beginning since the end, for many other people, is their HIV diagnosis. My beginning consists of owning my sexual self and not allowing our culture to weaponize it. [lead_gen showIfLoggedIn="0" campaign="shortcode_posts" source="site"],PrEP or pre-exposure prophylaxis has been out here for over seven years, I believe. It has been shown to reduce the transmission of HIV by more than ninety percent when taken as directed. However, most people don’t even know that it exists as an option. Many groups can benefit from PrEP PrEP is heavily marketed to men who have sex with men. However, very little research and marketing of PrEP has been targeted at female-identified populations. Anna Forbes, an HIV writer and activist, sums up the state of affairs this way:1 Even the pamphlet from the Centers for Disease Control and Prevention (CDC), called 'Talk To Your Doctor about PrEP' features a male couple on the cover—and no parallel version targeted to cisgender or transgender women, gender-nonconforming individuals, or straight couples seems to exist. This fact is really alarming when studies show that these populations can benefit from the implementation of PrEP. The US Women and PrEP Working Group is working to make a change in how PrEP is researched, implemented, and marketed toward women. Interested in sharing your story about PrEP? Share my experience Women, HIV, and PrEP I recently wrote an article illuminating the need for PrEP to extend to sex workers and it showed me how little research is being done concerning this population. In 2013, the U.S. Women and PrEP Working Group responded to this lack of research by conducting their own informal interviews with 100 female-identified individuals across six different cities in the United States. The goal, not being scientific or statistical rigor, was to get a sense of common themes and perspectives from women on HIV and PrEP. Unique concerns and considerations The working group learned that most women did not know what PrEP for HIV prevention was at all. The concerns that women brought up were really unique. Aside from cost, access to medications, and side effects, these women were also concerned with coercion to take the medication by partners, difficulty negotiating condom usage with partners, and drug interactions with hormone therapies and recreational drugs. [poll nexus_id=10379] Women are missing from PrEP messaging When most respondents in a population don’t know about a particular medication, that means that the word is not getting out. Although efforts may have gotten better since 2013, the reality is that most women still are not considered in the marketing of PrEP especially among people that have some high-risk activities within their lifestyle. The parallels of this lack of knowledge continue a legacy of female bias when it comes to sexual health topics. The female condom is one example of a tool that was meant to empower women to protect themselves. However, the commitment by the health community to engrain it in our cultural sexual education failed and it is always seen as an option that men and women don’t fully embrace. PrEP is only useful if people know about it Tools are great, but if they go unused they have little value to anyone. With the advent of new HIV tools, we should not miss the opportunity to re-evaluate how the implementation of these resources are distributed disproportionately. We, as community members, can spur change by pointing these inconsistencies out and insist on changes to these approaches that have left out vulnerable patients. Can you relate? Join the discussion Share my experience [lead_gen showIfLoggedIn="0" campaign="shortcode_posts" source="site"] Taking PrEP every day isn’t complicated. If you are taking it i pill form, it’s just one pill a day and you have pretty excellent protection against HIV if you don’t miss it. However, just because it is easy doesn’t mean it’s not hard to do. Coming from my perspective, I can admit that developing strategies to meet this demand can be tricky. I think I mentioned before that this effort even boggles the minds of public health researchers, scientists, and medical providers. The challenge of getting healthy individuals to take oral PrEP as prevention really involves a lot of behavioral factors that vary for every person, and I don’t believe any one strategy will hold the eventual answer. I wanted to look at some more ways people track their use of PrEP. Helpful tips for PrEP adherence Pill box Do you remember that pillbox your grandma had? It was labeled with every day of the week, Monday through Sunday. At the beginning of the week, they would fill up the container and faithfully follow the days. This one works pretty well especially if you are on other daily medications. Pairing medications with the consent of your doctors and pharmacist’s recommendation is a great way to keep one accountable for your entire health regimen. If you practice these methods, eventually the use becomes habit. Apps with daily reminders Now if we step into the twenty-first century, we have apps for that too. Take a look in your smartphone app store and search for pill reminder tools. I found the ‘Tablet Reminder Tool’ as a simple and effective way to stay on track with my medication. Drugs.com also has a pill reminder app that allows you to put in multiple drugs and even can remind you when it is time to get a refill on your prescription. Paper calendar or planner If you’re not into technology, you should also consider using a paper calendar or planner to keep up with your medications or add notes about side effects or interactions that may occur. Community or social circle Friends, family, and neighbors can also play a huge role in helping you keep up with PrEP. Sometimes a simple text from a friend can be the reminder that you need. Other times an accountability buddy could be taking PrEP with you as a way to assure each other is taking care of this task. Finding a close network of PrEP buddies is possible, especially among tight-knit friend groups and can be the support you need to stay consistent. These tips can help remember to take PrEP All of these methods are ways to make this not-so-complicated task a breeze. Having tools at our disposal is the key to success when taking oral PrEP every day. When we stay accountable to ourselves, we feel accomplished, proud, and healthy. PrEP is now available as an injection. To learn more, click here. Share with me your strategies to stay consistent in taking your PrEP regimen. Check out my other articles here and comment below. [lead_gen showIfLoggedIn="0" campaign="shortcode_posts" source="site"] ,In mid-December 2021, the U.S. Food and Drug Administration (FDA) approved Apretude (cabotegravir) as the first injectable HIV preventive drug. Apretude is approved for pre-exposure prophylaxis (PrEP) to reduce the risk of sexually acquired HIV in adults and teens. This is the first alternative to taking a daily pill for PrEP.1 PrEP in pill form is 99 percent effective if someone can keep up with the daily regimen. However, doctors have found some groups of people have trouble taking a daily pill.2 The groups found to have trouble taking a daily PrEP pill include:2 Young men who have sex with men Those with substance use disorders People with depression Those who live in poverty The active ingredient in Apretude The active ingredient in Apretude is cabotegravir extended-release injectable suspension.3 How does Apretude work? Apretude is an integrase strand inhibitor (INSTI). This class of drugs blocks HIV from replicating and infecting new cells.1,3 Evidence for Apretude Apretude was studied in 2 randomized, double-blind clinical trials. Trial 1 included 4,566 HIV-negative men and transgender women who have sex with men and have high-risk behavior for acquiring HIV. Trial 2 included 3,224 HIV-negative cisgender women at risk of acquiring HIV.1 In both clinical trials, Apretude was more effective than PrEP pills for these groups. The hope is that an injectable medicine will be easier to manage and help more people avoid HIV.1 Possible side effects The most common side effects of Apretude include:1,32 Injection site reactions Headache Fever Fatigue Back pain Muscle aches and pains Rash Some people taking Apretude in clinical trials also developed liver damage and depression.1 Apretude comes with a boxed warning, the strictest warning given by the FDA. It has this warning because you must test negative for HIV before taking it. In clinical trials, drug-resistant HIV was found in people who had undiagnosed HIV while taking Apretude.1 These are not all the possible side effects of Apretude. Talk to your doctor about what to expect when taking this drug. You also should call your doctor if you have any changes that concern you when taking Apretude. Things to know You must weigh at least 77 pounds (35 kilograms) to take this drug.1,3 In the first month, Apretude is given 2 times 1 month apart. After that, it is given once every 2 months.1,3 You must test negative for HIV before beginning Apretude and each follow-up injection. This testing reduces the chance of developing resistance to HIV treatment.1,3 If you acquire HIV while taking Apretude, you must transition to an HIV treatment plan.1,3 You and your doctor will need to weigh the risks and benefits of taking Apretude if you are breastfeeding. Traces of the drug remain in the body for a year or more after you stop taking it so it may affect your baby.1,3 Before beginning treatment with Apretude, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs. For more information, read the full prescribing information of Apretude. 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All About PrEP for HIV Prevention

Tools For Loving

My PrEP Story

My PrEP Story: Part II

I'm Sex-Positive Because I'm HIV Positive

PrEPing for Sisters

PrEP Simple But Not Easy

Apretude, First Injectable PrEP, Gets FDA Approval

Ritual and PrEP

Are STI Rates Higher Among Daily PrEP Users?

PrEPing for Disclosure

Condoms versus PrEP?

Why Is Testing for HIV and STIs So Important?