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The HIV/AIDS epidemic was unprecedented and left a trail of sorrow and death in its wake. It was a period of uncertainty as healthcare providers struggled to make sense of the disease that was ravaging the gay community.
Unfortunately, as human beings often do when they are confronted with a situation they cannot overcome, the whole world sought to lay the blame on someone. The gay community, which was already despised and marginalized for the way its members chose to live and love, was an easy victim. The disease was at that point called GIRD (Gay-Related Immunodeficiency) and everyone assumed it was a punishment inflicted upon gay people for living like degenerates. Even healthcare professionals discriminated against gay men infected with the virus, and only a handful of them took those suffering from it in and sought to, at the very least, make their last days comfortable. A
A whole generation of queer elders was lost, and the effects of such a monumental scale of loss are still being felt even today. It was a dark time that most people would want to fade out of memory because of both the lost people and the mistakes made, but it is important to provide some context in this article. It was amid this hopelessness and despair that a drug, Zidovudine, also called AZT, was introduced as the first possible treatment for HIV. This was in 1987. About a decade later, scientists came up with the concept of Highly active antiretroviral therapy (HAART), which would subsequently become the new treatment standard that is used today. The world could breathe a sigh of relief. People living with HIV/AIDS were no longer condemned to die slow, painful deaths. Research still goes on, of course, as the goal has always been a cure for the disease. In the meantime, two groundbreaking discoveries have been made: Post-exposure prophylaxis (PEP) and Pre-exposure prophylaxis (PrEP).
PEP is a short course of anti-HIV drugs you can take to reduce your chance of being infected with HIV if you have already been exposed to the virus. This course of drugs has to be started less than 72 hours after exposure for it to work. PEP was first used in the late 1980s by healthcare professionals who had been exposed to HIV in their line of work. In 1990, the Center for Disease Control (CDC) issued guidelines for the use of ARV drugs for post-exposure prophylaxis.
However, the invention of PrEP, which is medicine taken to reduce the risk of being infected with HIV before exposure to the virus, did not come until over two decades later.
In 2012, The Federal Drug Administration in the United States approved a drug for use as PrEP under the brand name Truvada, and two years later, the CDC released guidelines recommending its use among high-risk groups like trans people and men who have sex with men. In 2019, a second drug, Descovy, was also approved by the FDA as PrEP medication for cis men and trans women.
All these discoveries have gone a long way toward breaking the stigma surrounding HIV/AIDS. Men that have sex with men have one less thing to worry about. Now we’ve given some background, we’re going to talk about PrEP, how it works, who can use it, and so on.
PrEP is a drug taken by HIV-negative people to reduce the risk of being infected by HIV if you’re exposed to the virus. It is a prescription tablet taken daily, and it is usually given to people who are regularly exposed to HIV. This includes healthcare professionals like doctors, nurses, etc who work with HIV-positive patients; adults, as well as adolescents, consistently having unprotected sex with a partner or partners of unknown HIV status; drug users who share needles with people of unknown HIV status; and people with HIV-positive partners who are trying to get pregnant and/or breastfeeding babies. Other at-risk individuals outside these groups can also be prescribed PrEP by their doctors, depending on their circumstances.
Although PrEP is not a hundred percent effective, it has been chosen to prevent HIV infection through sexual intercourse in about ninety-nine percent of cases. In other situations, such as through cuts, injections, etc., the rate of prevention drops to about seventy-five percent, and people who suspect infection through this means should also follow up with a course of PEP.
We’ve mentioned before that you should ensure that you are HIV-negative before you take PrEP. This is because starting a clause of PrEP when you are already HIV positive can lead to drug resistance, making it difficult to treat the HIV. Take a test before you ask your doctor for PrEP. The drug works by preventing the replication of HIV in the human body. The main drugs used for PrEP are Truvada and Descovy. Truvada is made of tenofovir disoproxil fumarate and emtricitabine, while Descovy is made of tenofovir alafenamide and emtricitabine. These drugs are part of a group of antivirals called nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs). They act as catalysts, helping the body to produce antibodies. After they make contact with the virus, they block the enzyme that it needs to replicate, thus preventing infection.
PrEP can be taken daily, on a regular schedule. This is for people who are frequently exposed to the virus. It usually consists of a single pill, taken once or a day. It can also be taken On-demand. On-demand PrEP consists of two pills, taken between two and twenty-four hours before possible exposure to the virus, and one pill taken for two days after the last exposure. Truvada is the only drug that has been approved for on-demand use. It is also the only PrEP that has been approved for use by all genders and sexes. However, On-demand PrEP should not be taken by cisgender women, transgender men, and anybody with a vagina. This is because PrEP needs to be taken daily for at least 20 days to reach full protection in the female genital tract.
Descovy is limited to cisgender men and transgender men, pending further testing. It is not approved for use by cisgender women and should not be used during pregnancy.
Before you take PrEP, here are a few things you should consider:
Mental health: You may find that you need counseling and mental health support if you’re on a PrEP regimen. Talk to your doctor or healthcare provider about accessing counseling if you need it.
Lifestyle: Oral PrEP requires a regular commitment. Skipping doses may lead to resistance against the drug. If your lifestyle does not support taking a regular oral pill, you should opt for the long-lasting, injectable PrEP.
Weight – PrEP is only to be taken by adults and adolescents who weigh at least seventy-seven pounds.
You should also consider that there are other sexually transmitted infections (STIs) besides HIV. These are not prevented by PrEP, and can also have their own harmful consequences on the health. Using condoms and regular STD screening is advised.
If you’re planning a vacation and you’re likely to be exposed to HIV (i.e., you want to hoe like there’s no tomorrow) then you should probably take enough PrEP with you to last your trip. If you’re travelling to Western Europe or North America, you may find PrEP there. In other more conservative countries, you may not. Either way, it makes more sense to lack what you need instead of hoping and potentially being disappointed. Imagine having to go surfing or swimming instead of getting your back blown out and your guts rearranged like you originally planned.
Traveling with PrEP requires some preparation, so if you’re planning to go on a vacation and take some of these little blue pills with you, make sure you plan in advance to avoid being overwhelmed or skipping any steps.
The first thing you should do is get a prescription. Depending on where you are going, you may not end up needing it. Still, it is best to have it on hand, just in case. Make sure it is signed and looks as official as possible. You don’t want to be delayed at the airport if you can avoid it. If it’s happened to you before, you probably know it’s not a fun experience.
After you’ve secured the prescription, the next thing to do is obtain the pills. Make sure the expiry date falls outside the period of your vacation. You don’t want to be stuck in the Maldives or Saint Barts with expired PrEP and nowhere to get more. Also, check that the pills are not crushed or chipped before you travel. Make sure they are appropriately packed to avoid damage during the journey.
Asides from PrEP, you should carry condoms and lube. Your potential partners may not be aware of PrEP and may be wary of hooking up with you without protection. Also, there are other nasty bugs like Syphilis that you should prevent. Purchase travel insurance if you can, and once you get to your vacation location, check out the nearest clinic and/or pharmacy. Having healthcare on hand may be the only thing that stops your dream holiday from turning into a nightmare.
PrEP is an incredible discovery that has saved and improved many lives, but like all drugs, it should be used sensibly and responsibly, following the advice of a doctor.