PrEP: Preventing HIV and stigma

A few days ago, I walked out of Kelley-Ross Pharmacy in Seattle with about a month’s worth of PrEP, or pre-exposure prophylaxis. PrEP is an anti-HIV medication that reduces the risk of HIV-negative individuals of contracting HIV. PrEP, which is also commonly referred to as Truvada, is an additional method of safe sex practices within the gay community, but it can also be used by other individuals with a high risk of HIV infection such as those who use illicit drugs, exchange sex for other commodities or have had diagnoses of sexually transmitted diseases.

Kelley-Ross has a one-step PrEP program, which promises their patients that they can walk out of the clinic with a bottle of Truvada in hand at the end of the first visit. For me, the process was slightly different because of an insurance mix-up, but if I did have an active insurance provider at that time, I would imagine that Kelley-Ross would’ve stayed true to their claim.

I’ve done light research in the past about PrEP and initially decided to not get a prescription for it because the process appeared too complicated. At that time, I was looking at the Washington state Department of Health PrEP application, which requires applicants to mail or fax in a form to the WA DOH in Olympia, then wait for a few days or weeks to determine eligibility. When a friend introduced me to Kelley-Ross, I was quite surprised with how accessible Truvada was.

Considering my experience with getting Truvada, I have realized that even within the gay community, not everyone knows what PrEP is, how it works or why it’s important. In fact, HIV stigma within the LGBTQ community is still quite prevalent. In my experience, it’s interesting how these stereotypes are perpetuated by other gay men who are completely oblivious about the current progress with HIV treatment and prevention. By calling oneself who is HIV-negative clean or drugs and disease free, it conversely profiles an HIV-positive individual as a dirty, drug addicted sexual deviant.

However, like all stereotypes, that may not be entirely true and much of the stigma is based off false information. The science behind PrEP is really fascinating and everyone should try to understand the basics behind the interaction between HIV and PrEP. When an individual contracts HIV, the disease has an incredible ability to mutate rapidly. The virus can introduce a mutation once every 2000 nucleotides, the building blocks of DNA. This allows HIV to constantly form new mutations and variants of itself, which makes it difficult to control. PrEP prevents those mutations from occurring by blocking an enzyme in HIV called reverse transcriptase so it is unable to replicate itself.

There are also medications available for HIV-positive individuals. These treatments suppress the virus count, which prevents transmission to other people.

Understanding the science is the first step to diminishing stigma against HIV-positive individuals. As a medication that reduces the risk of HIV infection, it falls into the category of safe sex methods and as a result, its information should be readily available in clinics, hospitals and even universities.

If anyone is seeking PrEP, it’s crucial to first determine if one’s insurance will cover the medication. I’m on Washington’s Apple Health plan, which covers the full cost of Truvada; however, without insurance, one should expect to pay upwards of $1300 per month for the treatment.

PrEP cannot replace condoms and it must be used as an additional method of contraception, similar to birth control. While Truvada is designed to fight against HIV, it cannot prevent other STIs. In the context of HIV prevention, PrEP is very effective, reducing the risk of HIV infection by more than 90 percent, if it is taken daily.