Blue Pill

If I know you I've likely mentioned this, and I post so infrequently I doubt many folk are reading anyway! But in case anyone is reading and didn't already know I started taking PrEP a little over a month ago. The linked page there explains what it is in more depth but in essence PrEP is the regular use of an anti-retroviral as a prophylactic, and it has proven very effective at preventing HIV infection. It offers 99% effective protection against the virus.

At present it's not available on the NHS here in Scotland (hopefully it'll clear the regulatory hurdles soon) so at present - like a lot of gay men have been recently - I'm buying the medicine myself. My local NHS sexual health clinic (Chalmers) have been quietly encouraging "high risk" individuals to consider this ahead of it becoming available on prescription, and they're supporting me with liver/kidney function tests etc. to ensure the drug isn't causing any harm.

Some of you will need some context here. Some of you will probably have had a chill reading that I'm considered "high risk" for infection. Some of you will be breathing a sigh of relief remembering holding my hand through past scares (thank you!). A handful of you will have had a similar experience of living in a world where sex and the spectre of an incurable (and once fatal) infection have been inextricably intertwined for longer than you've fully understood what sex was. That's at the root of my choice to start taking PrEP so let's start there.

Or rather, here:

If you lived in the UK and were old enough to watch TV when that advert aired you'll remember it. If you're also gay it probably coloured your attitudes to sex in a pretty profound way, and probably not positively.

It was clearly well intentioned, and commendably for the time it doesn't equate HIV and homosexuality... it's somewhat coy about it though, and since pretty much everything else at the time did equate the two, the impact for me and a lot of guys around my age was tying our formative sense of our own sexuality to an urgent and imminent danger of incurable infection and death.

That formative influence plays out differently in different people. Among guys I've talked about it with it splits roughly down the middle between instilling an almost religious faith in condoms, or resulting in a more empirical awareness that barrier protection is good but not perfect and so we accept a degree of risk whenever we have sex.

I've never been very religious.

That idea that even safer sex isn't safe is explored in more depth in the opening parts of the excellent Jeffrey which if you haven't seen already, you must, it's brilliant. For the purposes of this blog I'm going to lazily point to it's opening quarter as an in-depth exploration of the issue and move on.

My point being that I (like a great many gay men) accepted and internalised early on that my sexuality carries an inherent risk, and when you acknowledge that that risk is present to a greater (without condoms) or lesser (with condoms) degree, it colours your thinking. Bluntly it means you generally use the blasted things, but that you are inclined, under certain circumstances, to say to yourself: "there's risk either way so what the hell". (If that sounds like an over simplification it is, and I will come back to it, but it gets the point across for now)

I hadn't fully realised how fatalistic I felt about HIV until I was talking over things with a health advisor at Chalmers a number of years ago. In the course of the conversation she asked me directly (based on a few comments I'd made) if I felt my infection someday was inevitable? The question shocked me, but the realisation - that, yes! on some level I felt exactly that - was more shocking.

Sex and fear of HIV have been inextricably linked for me for as long as I can remember understanding and thinking about sex. As I mentioned growing up the spectre of HIV was always linked with being gay and as I came to accept myself as gay I think on some level I also accepted wrongly or rightly that one day I'd probably wind up positive.

To date I've remained negative.

As I said that chat with the health advisor years back shocked me, and I took up the offer of counselling to explore my own attitudes to my sexual health and my responsibilities to others concerning theirs. That counsellor was excellent, we covered a lot of ground and I'm not recounting it all here, but the upshot was an exorcism of sorts. I shed the ingrained fear that had got tangled up with my sexuality, and I built some good habits, like a properly regular sexual health screening habit, and the habit of being more direct and open in talking about sexual health, the habit of discussing condom use (or not) and trying to make informed shared decisions with different partners about what level of risk was or wasn't appropriate for us.

All of which is of course against a backdrop of HIV becoming eminently treatable and no longer the terrifying death sentence it loomed as in "Tombstone", Jeffrey or in my youth. It's also against a backdrop of various of my friends over the past decade or so testing positive, and my seeing the virus' still significant impact first hand.

Broadly though, fear and that sense of inevitability went away, and were replaced with a sense of ownership of my own sexual health choices, a strong sense of my responsibility to my partners and an ability to talk about those choices, but each choice still boiled down to putting my faith in condoms or not, and that seems a good point to come back to my gross over simplification from earlier.

A great many gay men maintain they always use a condom. If you do and that's true then that's great -good for you. However a great many gay men who maintain they always use a condom, don't, and that's dangerous. Throughout my 20s I maintained I always used condoms. Throughout my 20s I did not always use condoms. In my 30s I began being more honest about that and immediately ran into the main reason most gay men simply lie.

Early on in my attempts to be honest and discuss sexual health choices with prospective partners I was staggered by how vehemently some men responded, and the abuse I got for trying to have a grown up discussion about it. To be clear I'm happy using condoms, but I honestly prefer not to if it's an option, and I don't share some peoples' blind faith in them (they break) but even knowing what a touchy subject it can be, I was staggered by how even just discussing the issue was taboo for some guys.

There's tremendous pressure to say we always do, but saying when we don't always use a condom is vital because it's the first step in owning our own and our partners' health. Pressurising people, sermonising and judging people who are honest about their own fallibility (or their own informed choices) is dangerous in my opinion.

Now I - like many other gay men - have added a layer to my armoury of preventative measures. As well as having condoms to hand if they're the preferred option, I also take a pill every morning which blocks that one incurable virus from infecting me should I be exposed, as part of the medical care surrounding that pill I also get a full sexual health MOT every three months. By any rational measure I'm being very responsible but just like before I and other men on PrEP find ourselves being vilified as irresponsible by a significant number of our peers and the press - "just use a condom" is trotted out as if that's what everyone else is doing. As if that's always going to work.

So to finish I'm going to share an infographic I made as part of a self promotion project, it's intended to both explain what PrEP is to folk encountering it for the first time, and to drive home why it's such a miraculous thing, and why increasing numbers of gay men are shelling out for it themselves (whether or not they can really afford it).

The numbers come from here and are among the more modest results. New HIV infection rates in places like San Fransisco (where PrEP has been available longer) have been dropping steeply since 2012. If "just" using a condom had been the answer to HIV we'd not be seeing these kinds of results.

Personally that one blue pill each morning has eradicated the last scraps of fear and inevitability still tied to my own sexuality. It gives me peace of mind, and a greater sense of control and security about my own and my partners' health. It's something that I strongly feel needs to be talked about more openly and more widely until we can kick this absurd reactive taboo surrounding grown-up conversations about our actual sexual health choices (instead of the "always" lie so many of us tell).

Part of the idea of rebranding business-me as last year was to create a church/state kind of separation between personal and work "me" but life's never that clear cut so it tickles me that my first post here in six months represents a slightly muddy mix of the two :D )


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