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July 8, 2014

PrEP Editorial by: David Ponsart There’s been a revolution happening quietly in HIV prevention in the US, and you may not have even realized it. Late in 2012, the FDA approved an existing HIV medication called Truvada for use by HIV negative folks for the prevention of HIV infection. This has the potential to change HIV prevention as we know it and curb the roughly 50,000 new infections that happen every year. When taken daily as directed, PrEP has been proven to be as much as 99% effective in preventing HIV infection. There is a battle going on behind the scenes. Some people within the HIV community are resistant to using this new tool. They say that gay men will stop using condoms; the spread of STD’s will be rampant. They say that PrEP is too expensive and condoms are a cheaper better alternative to taking a pill once a day. All of those things may be true. Gay men are already not using condoms. If they were, we wouldn’t have 50,000 new infections a year. STD’s are already rampant in both the gay and straight communities. There have been strains of treatment resistant Gonorrhea found all over the country. There is no question that PrEP is more expensive than using a condom. One principal that we should but don’t always consider when talking about HIV prevention is that everyone is different.

It’s not our job as providers to tell you what or how you should behave. As an HIV counselor myself for 20 years, I can only give clients the information they need and let them decide for themselves what the best solution is for them. Some clients are happy abstaining from sex, and are waiting for the right guy to come along. Others have no issues with condoms and use them religiously. PrEP is not intended for them, they have already found a solution that works for them. There are many gay men who, despite their best efforts and intentions, sometimes slip up and don’t use condoms. There are others who are in relationships with a poz guy whose viral load may be uncontrolled, allergic to latex, hate condoms and never use them regardless of the risk, these are the people who will benefit the most from PrEP. The real battle is with the homophobia and sex phobia that we, as gay men, have internalized over the last 30 years of dealing with HIV. We have been conditioned to view our sex lives as dirty, promiscuous, and something that has to be suppressed. We have internalized phrases like “unprotected sex” , “barebacking” and all the negative connotations that are associated with it. In the straight community it’s all just sex.

The sexual liberation that started in the 70’s was quashed because of AIDS, and rightfully so for the time. This is a revolution because for the first time since this insidious virus invaded our community, we have a weapon that doesn’t REQUIRE condoms to be effective. This is the moment that we have been looking forward to since the beginning. We have an entire generation of gay men who have internalized and accepted that their sexual expressions and desires are “dirty” and have to be “protected”. The most vocal critics of PrEP as prevention are simply expressing what many of us have internalized as facts. This is going to require us to re-evaluate the way that we view our sex lives and sexual expressions. In order for PrEP to be the revolution in prevention that it has the potential to be, we have to end the slut shaming, and let go of our own negative feelings about our sexual desires. If we can do that, we may put HIV to rest for good. Our own views about our sexual desires are not the only obstacle. The struggle we face with implementation of this new strategy is multifaceted. Primary care doctors, who are not familiar with HIV medications, are reluctant to prescribe PrEP to HIV negative patients. Infectious Disease specialists are overburdened with HIV positive patients and may not be able or willing to accept HIV negative patients just for PrEP. Powerful national voices are denouncing the use of PrEP and calling it a party drug, prompting a counter movement with the twitter hashtag #Truvadawhore. A huge barrier is simply increasing awareness of this option for gay men. Supply will follow demand, and when more gay men are asking their doctors for PrEP, doctors will learn about it and make it available. At the end of the day, the most important voice in the discussion is missing and that is yours. The responsibility for remaining HIV negative is yours and yours alone. You are the one who decides what prevention strategy works best in your life, in your situation and your sex life. PrEP may be right for you, it may not. There are many factors to consider, including cost and long term potential impacts on your body. All of those are between you and your doctor, and nobody should be shaming you into avoiding PrEP, or creating barriers to accessing it. Be a part of the revolution. Talk to your friends about it, talk to your doctor about it, talk to anyone who will listen. We have all the tools we need to create an AIDS free generation. We just have to use them.

Nutrition Tips

Research healthy restaurants. Start each lunch/dinner with salad. Drinking a glass of ice water can burn 25 calories! Don’t leave yourself dehydrated. Water flushes out fats and toxins. The best healthy cuisines are Indian, Thai, Japanese, Chinese, Mexican and Greek. Buy food in its season (e.g. strawberries in summer). Buy from local farmers. Veggie broth is a great healthy choice. Eat less, enjoy more. Make your own instead of buying in jars.

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Go Green Tips Save energy to save money. Stop using disposable bags. Order some reusable bags—my favorites are Flip & Tumble. Or, make your own—they’re insanely easy. Buy an inexpensive reusable water bottle, and stop buying plastic disposable Wash laundry in cold water instead of hot.

Be a Hero to Someone

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Editor: Mike Shannon, Tim McKee Publisher: John Krepp

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