Saturday, January 16, 2016

Who Should Use PrEP?

Lots of folks! 

PrEP (Pre-Exposure Prophylaxis) is a daily medication that is available by prescription. People that are at high risk for HIV may choose to use this medication to prevent HIV. Like any medication there are risks and benefits to taking it. We encourage you to use your best judgement and talk to your clinician and see if it's right for you.  

We put together some stories about the kinds of reasons someone might choose to use PrEP (Pre-Exposure Prophylaxis for HIV Prevention). Please note – these are composites of actual people and situations.

Mike is a 41 year old man from Towson. He identifies as gay and lives in a cute house with his husband, a picket fence and two dogs. He travels frequently on business. He and his husband have an open relationship. When Mike travels he likes to have anonymous sex with other men. Having a conversation about HIV status isn’t something he usually does and he assumes some of the men he has sex with are HIV positive. He uses condoms most of the time, but occasionally a condom fails or he gets carried away and doesn’t use one. Mike has decided to use PrEP as extra protection against HIV.

Julie is a sex worker. She works on the street in Baltimore and frequently finds that she can make more money if she doesn’t use a condom. Sometimes, even when she insists on using a condom, her client won’t listen or will remove the condom part way through. She decides to use PrEP because it is prevention that she can control.

Shavon and Norman have been married for 15 years. They met at a NA meeting and are both in recovery. Before he got sober, Norman contracted HIV from sharing needles. He is currently medicated and his viral level is undetectable. Their doctor has informed them that the risk of transmission is very low, even if a condom breaks. However, when she was young, Shavon lost people close to her to HIV and she is very frightened of contracting the virus. Any time a condom breaks, she panics and is worried for weeks. As a result, she and Norman don’t have intercourse as often as they would like. Shavon decides to take PrEP  for additional peace of mind.

Chase is a gay man in his early 20s in Baltimore. He loves to party. Sometimes he hooks up with guys in the bathroom at the club, or picks up men from Grindr. When he’s partying he likes to use alcohol and other drugs. The morning after, sometimes he doesn’t know if he’s used a condom or not. He’s not interested in changing his alcohol and drug use at this time. He’s tried and he always ends up in the same situation. So he decides to changes something he knows he can change. He sets a daily alarm in his iPhone and gets a prescription for PrEP.

Olivia lives with Mark. She suspects that he’s cheating on her frequently. Sometimes she sees needle marks on his arms. He denies both the cheating and the drug use and insists that they don’t need condoms. Olivia loves Mark and keeps hoping he’ll change. She’s not ready or willing to leave him. She goes to the doctor and starts taking PrEP. She puts the pills in a vitamin bottle so he won’t know what she’s doing.

There are as many reasons to take PrEP as there are people who take PrEP. If you want to learn more, we hope to see you at the workshop at Sugar on January 24th at 6:30 pm (free). Or check out this website!

Thursday, January 14, 2016

What the heck is PrEP?

Thirty years ago HIV was decimating the gay community across the United States. Gay and bisexual men were dying by the thousands. The average life expectancy of someone with HIV was months or years. It was a terrifying time.

Today, the picture looks a little different. People of all sexual orientations are living with HIV. It’s still way to common in the communities of men who have sex with men. And way too common in communities of color. The good news is, an HIV diagnosis is not the death sentence it once was. With proper treatment, one can expect to live an average lifespan. And, due to programs like the Maryland AIDS Drug Assistance Program, everyone in Maryland should be able to access both treatment and medication. However, living with and treating HIV is not a cake walk. It involves daily medication, doctors visits, often benefits from life style changes, and can make treating other illnesses more complicated. In other words, although HIV is now treatable (which is awesome), it’s not (yet) curable. It’s not something one wants get.

As you know, HIV is transmitted through the exchange of body fluids between an infected person and an uninfected person. The two most common ways that happens is through anal or vaginal intercourse or through sharing needles. It would be lovely if people were able to use condoms each and every time they had sex that might put them at risk for HIV exposure. But, this is the real world. Most of us who rely on condoms for disease prevention or pregnancy prevention have a story about a time that either the condom failed, or we failed to use one. Because we’re human. We make mistakes. Things happen.[1]

Wouldn’t it be great if there was second line of defense against HIV?

There is. It’s called PrEP[2]. It’s a pill that someone who is HIV negative takes every day. If the medication is taken correctly it’s over 99% effective in preventing the transmission of HIV. In fact, a recent study found that even with not perfect use, it was about 50% effective. With perfect use, it’s amazing. And even with inconsistent use, it’s able to significantly lower your risks.

So, is PrEP a good idea for you? It depends. It depends mostly on what kind of sex you have and who you have it with. Are you someone who’s at high risk for HIV?[3] If so, this might be a great option for you.

Want to learn more? Kip Castner from the Center for HIV Prevention at the Maryland Department of Health and Mental Hygiene is teaching a free workshop on PrEP on Monday, January 18th at 6;30 pm at Sugar. We hope to see you there! You’re worth it!

Here’s some links to more info:

Baltimore Needle Exchange Hours & Locations (they also offer HIV testing):
Hours of Operation
Monday 9:30 AM - 11:30 AM
Monroe & Ramsey
Monday 12:45 PM - 3:30 PM
Westwood, Mount & Calhoun Streets
Monday 3:30-4:45 pm
Park Heights & Spaulding
Monday 6:00 PM - 8:00 PM
Baltimore & Conkling (Highlandtown)
Monday 8:30 PM - 10:00 PM
Freemont & Laurens
Tuesday 9:30 AM - 11:30 AM
Montford & Biddle; Pratt & Carey
Tuesday 12:45 PM - 3:30 PM
Freemont & Riggs, Barclay & 23rd
Wednesday 3:30 - 4:45 pm
Monroe & Ramsey
Wednesday 6:00 PM - 8:00 PM
Baltimore & Conkling (Highlandtown)
Wednesday 8:30 PM - 10:00 PM
Freemont & Laurens
Thursday 9:30 AM - 11:30 AM
Pontiac & 9th Ave.; North & Rosedale
Thursday 12:45 PM - 3:30 PM
James & Ostend; Monroe & Ramsey
Thursday 7:00 PM - 10:00 PM
Baltimore & Gay (The Block)
Friday 9:30 AM - 11:30 AM
Park Heights & Spaulding
Friday 12:45 PM - 3:30 PM
Westwood, Mount & Calhoun Streets
Friday 3:30 PM - 4:45 PM
Barclay & 23rd
Friday 6:00 PM - 8:00 PM
Montford & Biddle
Friday 8:30 PM - 10:00 PM
Monroe & Ramsey
Saturday 12:00PM - 4:00PM
Fremont & Riggs

[1] Do you use needles for drugs or black market hormone therapy? You should know about  Baltimore’s Needle Exchange program. They’ll provide you with clean needles and support. If you want access to hormones through a doctor, Chase Brexton has an awesome sliding scale program. They’ll even help you get insurance!
[2] PrEP stands for Pre Exposure Prophylaxis – which is  fancy way of saying prevention
[3] Who’s at “high risk” for contracting HIV from sex? That’s a good question. Generally, the following groups of folks are considered to be at higher risk: men who have sex with men, women and people of other genders who have sex with men who have sex with men, sex workers who have unprotected intercourse with clients, people who have unprotected intercourse with people who share needles, people who have unprotected sexual intercourse with people of unknown HIV status. You and your health care provider will do the best job of figuring out if PrEP is right for you. What’s important is that you be as honest as possible with your health care provider. You’re probably not going to shock them.