World AIDS Day

***Note – I actually wrote this post in 2015 but thru some sort of typo it got scheduled for 2016.***

World AIDS Day has a special meaning to many of us in the LGBT community. If you are over the age of 40, it is extremely unlikely you haven’t personally lost at least 1 friend or loved one to AIDS. While it is more of a chronic illness in western culture these days, it is still incurable and people are still dying. While I lost several friends over the years, two were very close to my heart and I use this day to fondly remember said individuals. Today I want to talk about Damien.

Damien was the manager of the Club Houston.1 I happened to meet him at a very rough time in my life. The first time meeting him left me a bit rattled actually. I was still young and very naive at the time. And while I’ve always been able to put on a good poker face, I was very intimidated by him. He was this rather imposing figure. He carried himself w/a bit of what I referred to then as arrogance. It helped his image that he was tall and lean. He had long curly hair, of which he he was very fond. He had a reputation for being very strict and frankly, being a bitch. As I would discover later, it was all a cover. He was actually quite kind and generous. He just had a really low tolerance for drama.

For myself, I was struggling to not be homeless at the time and ended up working at the Club for money on weekends. I’d come in and do the weekend bbq and they paid cash. Considering I was sleeping in my car at the time, I wasn’t in a position to refuse. Being funny and social, I quickly went from just weekend work to weekday work on a full-time schedule. Damien quickly fell in love with me (as a friend and mentor). One, I was a hard worker2 but that just served to get his attention. He loved me because, as he put it, “I was the nelliest funniest queen he’d ever met” For you long timer readers, you’ll remember I turned myself into a stereotype back then because I thought that’s what I had to be to gain acceptance. And truth be told, you would not have even recognize me then. But he loved me because I was so fiercely “out.” Anyway, back on topic.

After a little while, word filtered back to him regarding my situation and my routine unofficial overnight hangouts became a sanctioned activity. Employees were allowed to use the ‘gym’ for free. hehehe It was a huge burden lifted for me. A couple of the employees didn’t like me because they knew I’d rat their lazy asses out if they got high and slacked off while on duty. Said slacking meant more work for me. They would routinely kick me out after my time limit expired at night. This left me on the street anywhere from 4-6 hours in the late night/early mornings. The police were not friendly and the neighborhood wasn’t overly safe so I’d drive to a nicer area of town and park in well-lit areas. Anyway, what very few people knew at the time is he also helped me behind the scenes as well. I was the beneficiary of a monthly “employee of the month” program that seemed to only exist for my benefit. Said program paid extra cash to the winner. Damien grew to trust me a lot and was also a mentor to me. Having been thru some of life’s harsher roads before me, he would often share pearls of hard earned wisdom with me.

After a year or so, I moved on. While I had no shame in working there, I didn’t intend to stay that way. I’ve always been a quick study and any time life presents an opportunity I take it. I continued working and finding better jobs to better myself. Damien and I stayed in touch and I’d routinely lend a hand if he asked. An employee would get fired or just disappear and he’d call me for a quick shift. I was glad to help someone who helped me.

When Damien got sick, I was living in Boulder, CO. I caught a flight back as soon as I could and got back in time. It is a surreal experience to see the life and health leave someone you know. Gone was the vibrant man I knew. In his place was the decaying shell of a human being. In a word, it was ghastly. I loved this kindred soul and it broke me in so many little ways to see him reduced to this. When he passed away, I promised I’d never let myself die that way. I’d never let anything reduce me to such a state. (Kids say the craziest things when we think we are invincible)

[This part is new since I wrote this.] So today, I celebrate his life. He wouldn’t want me to be sad or down. He would want me to be fierce and alive. So in his honor, I celebrate the life of all of those we’ve lost due to AIDS. I celebrate the life of those who still live with AIDS. I celebrate their courage in the fight to live. I celebrate the new treatments and drugs available to everyone. Besides treatment drugs we also have PrEP now.3 PrEP is changing the landscape of treatment and transmission.

I celebrate the kindred soul that touched my mine and helped me on my own path.

Hope springs eternal…

  1. One of two large bathhouses in the city []
  2. yes, even in a bathhouse. []
  3. Pre-Exposure Prophylactics []

PrEP

So I’m diving head first into a topic of news lately regarding PrEP. *This is a bit of a long post today so grab some caffeine*

If you aren’t familiar with the term PrEP, it stands for Pre-Exposure Prophylactic.1 The drug Truvada has been on the market to treat HIV since the late 90’s. It was recently approved to help with the the prevention of HIV transmission for individuals that are HIV negative. This news has been received with some very mixed reviews from within the community and the fight over it rages on.

The disturbing part is not that the decision is contentious but that there have been attempts to silence or shame anyone who has embraced the option. I must say I don’t really understand the latter. Even worse, much of the criticisms are based on ignorance and baseless (so far) assumptions. I get the advice for caution and concern but the level of vitriol and condescending attacks is unnecessary and counter-productive. If you don’t understand something don’t ramble on about how awful it is because ‘you know someone will abuse it.’ As often turns out, you don’t know and that ignorance can cause real harm in this instance. You have zero right to demean anyone who would choose a path that may help prevent them from getting HIV, even if that path doesn’t line up with your personal preferences.

I blame some of it on our conditioning in Western culture to hate our bodies and/or any idea of sex outside of coupling. We are institutionalized from birth on 1man+1women=babies. Well, that social construct doesn’t apply so well for us same-sex lovin’ folks. And having moral apprehension to a method to prevent the transmission of HIV is perfectly fine for yourself. Sex is not dirty, wrong, or shameful. And this continual shame based approach to sexuality is reprehensible. Frankly, it should dispel any remaining allusions that we are in any way unique or more evolved than our straight brethren.

This particular argument isn’t about personal standards. It is about the prevention of HIV transmission. Infections are once again on the rise at an alarming rate.2 And while HIV may not be the death sentence it once was, it is still incurable. It is time to branch out and embrace more ways to combat the spread. The ‘you should use a condom’ argument has soundly failed, as evidenced by the continual rise in infections from a generation that missed the mass die-off in the beginning. And why we of all people continue to fall prey to this failed ideology escapes me. The ‘you should’ method has never worked. If it did, we wouldn’t have teen pregnancies, drunk drivers, continued HIV transmission, or even wars for that matter. You are right, people should use a condom. Many do but many more don’t. It is time to fight the transmission from a different angle and from as many angles as we possibly can.

There are some pros and cons to going on PrEP. It isn’t for everyone based on your risk-factors, health, eating/drinking habits, relationship status, etc. If you have questions or concerns, ignore all the hype and drama. Talk to your health care professional about it. At the end of the day, what I or anyone else thinks you should do is irrelevant. You should act to protect yourself and if this would help you, then you should consider it.

*

For my own view, I support the approach to limit the spread based on sound statistical evidence. So far, the studies are showing that PrEP is truly effective in preventing the exposure and spread of infection.

One big argument I hear has been people will use condoms less. Statistically, so far that proves to be inaccurate. Two of the studies (which use blind testing – meaning you never know if you are getting the real drug or a placebo) showed that overall condom use did not decrease. But let us assume for a moment that people did. How many times have you trusted a complete stranger to be honest about their status? And how many times have you engaged in riskier sex based on that belief? The way I see it, we have several scenarios3 where HIV transmission can occur:

Both partner’s know they are neg.
This is a fallacy. You should never assume someone who has sex with others besides you is neg. But let us assume for the moment, both partners think they are neg. You aren’t in a monogamous LTR and you engage in unprotected sex. Not being on PrEP means you are at the highest exposure rate for transmission. Being on PrEP would mean the ratio of transmission is reduced significantly (As much as 95% without a condom according to the efficacy rates of the studies so far).

One partner doesn’t know his status.
I would argue most of new transmissions via sex happen when one partner doesn’t know his status or assumes his status hasn’t changed. Again, if one of you are on PrEP, the exposure rate is reduced significantly.

Only one partner is neg.
Usually this means the poz partner is already on a drug regimen and undetectable. (You should still ask)  Plenty of sero-discordant couples already weren’t using condoms prior to PrEP. In an LTR or not, now the neg partner has an extra layer of protection and assurance he is not at risk. Not only does this reduce the transmission, it also de-stigmatizes the fear that comes from being with a poz person. Knowing you can be with a poz person and not put yourself at risk helps many who want to get past the mental mind-block, overcome their fear, and move forward.

Both partner’s know they are poz.
These are the least of your worries. These guys know their status and sero-sort on purpose. Primarily, to avoid the afore mentioned stigma that comes with being poz. I’d argue the only time this becomes an issue is when you get into assuming again. “We’re barebacking so he must be neg”, meanwhile, the other guy is thinking “We’re barebacking so he must be poz.” Never assume anyone is neg.

So which category do you fit in?

There are some cons and real concerns to consider. The biggest concern so far is the idea that guys will go on it inconsistently and cause resistance. Keep in mind resistance is only relevant if you sero-convert to being positive. Adherence to the daily regimen is key to the drugs efficacy. But think on this for a moment. The drug is already used for post exposure. Say you aren’t being very consistent with taking it daily. Then you have an exposure. How many of you reading this wouldn’t, out of that same fear, start taking it every day after an a possible exposure?

So far, the medical community is much more worried about resistance from folks that are using it as treatment, not preventative care. And let’s be real, people who spend the time, energy, and money to get on it as PrEP aren’t being cavalier. I’d argue they are doing just the opposite. It isn’t just a simple prescription. You have to visit your doc every 3 months, at least for the first year, for regular checkups and blood work. That decreases over time but you see my point. And when has a doc ever given you a prescription with an unlimited refill amount? See, when you think it thru you start unraveling some of the preconceived notions.

Another issue is cost. Fortunately, most large insurers already cover it so if you have insurance, chances are higher they do cover it vs not. I won’t even entertain the conspiracy theories I’m heard on this one.

And then we get to side-effects. The are some rare but sometimes very serious side-effects that can come from long term use of the drug. That again, is why you discuss it with your doctor and get regular blood work. Almost two decades of use show overall it is well tolerated by most. Even still, you are not given a prescription and never return. The hype over some of the more serious side-effects has been quite dazzling. I encourage you to go to WebMD.com and do a search for both Truvada and the little blue pill.4 No one is up in arms over the side-effects of the latter, which by definition aren’t much better. You can choose pretty much any drug site of choice to do a comparison.

In the end, you have to decide for yourself if this is right for you. If you are someone who uses a condom without fail (pun intended) then it may not be the choice for you. However, if you find that you aren’t 100% consistent and/or just want an extra layer of protection, then it might be for you. Talk to your doctor. Talk to others who are on it, regardless of their status. Decide for yourself if PrEP would be an additional way to combat the spread of HIV for YOU.

/rant

  1. Not to be confused with PEP, Post Exposure Prophylactic. The same drug is used for both []
  2. Ironically, many don’t stigmatize the treatment of other STDs, like Gonorrhea or Syphilis, that used to be considered terminal. []
  3. excluding needle sharing []
  4. I don’t want to attract the bots so I’m not spelling it out. lolol []