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Advice Please: On PrEP and Unprotected Sex with HIV Positive Partner?

Nov 13, 2017

Hi, There has never been a day in my life where I have managed enjoyed the pleasure that sex has to offer. Its always the fear of HIV that stops me from experiencing any pleasure that sex has to offer.

I tried my best to get into a long term monogamous relationship in the hope that I can do away with condoms and enjoy sex and intimacy without fear. I failed. I wanted to have sex without fear so I resorted to PREP. I joined a clinical trial and have been taking PREP every single day for the past 2 months and continue to take it daily.

While on holidays in Thailand, about 4 days ago, I had unprotected sex with a male sex worker, we had sex twice in the one night with me being the top. Im uncircumcised. I asked him what his HIV Status was and he said negative. Did I enjoy it? No. The fear was still there, so much so that the following morning I asked if he would get tested at a local clinic. He agreed.

We get to the clinic and finger prick test was performed on him. It came back positive and he was told to go to the local hospital for a confirmatory test. He refused. I was in shock. I went back to the clinic and they told me to go to the local hospital and speak to an Infectious Disease specialist and seek out PEP even though I explained I was on PREP.

I immediately went for a consult with the Infectious Diseases specialist at the Bangkok Pattaya hospital and explained the situation and that I had been on PREP for 2 months and still take it daily. She was shocked and explained Im at very high risk with the PREP Im currently will not be enough and that I needed to add Isentress. I hadnt cried in years and at that moment felt like throwing up. I got a script for Isentress which cost me a ton.

I took Isentress along with my Prep. The second day on Isentress I could barely move. I couldnt sleep, had muscle spasms, intense lower back pain and my whole body was tender and sore. I couldnt even manage to change my flight so I can head back home. I stopped the Isentress and didnt leave my hotel bed for 2 days. Please help me understand what I need to do now given that I could not tolerate the Isentress. I continue to take my PREP daily.

I called my Sexual health clinic in Australia who are running the clinical trial that Im enrolled in and the nurse I spoke to said the Isentress is not necessary and that I should be fine. I dont know who to believe. The specialist that prescribed Isentress said I was at high risk.

I have a sore throat, swollen glands in my neck and a mild fever. Im thinking the worst.

Im not on facebook but registered today as Ive read there is a support group Prep Facts: rethinking HIV Prevention and Sex. I have requested to join the group and currently in pending state. If you dont mind I would like to post my story there once my request to join is approved in the hope I can get some support. In the meantime, just desperate for some advice. At the moment, Im in this alone.

Response from Mr. Jacobs

Hi!

I understand your concerns. Most of us who came out as gay or bisexual men at some point in the last 36 years have been bombarded with a series of messages telling us that anal sex is dangerous, deadly, and deserving of punishment. It can be extremely difficult to untangle the irrational terror from the actual risk. That fear is what has prevented a generation of us from being able to truly enjoy the pleasure and intimacy of connecting with other men. You are definitely not alone here.

But let's start by looking at the risks and facts of your situation. Based on the experiences you describe above, it seems there is near zero possibility of having acquired HIV from this encounter. I say this because:

(1) You report having taken PrEP daily for over two months. Daily use of PrEP has proven to be over 99% efficacious in preventing HIV acquisitions (http://www.natap.org/2016/ICAAC/ICAAC_02.htm ; https://www.robertmgrant.org/project/has-prep-ever-failed/).

(2) Even if you weren't using PrEP, the likelihood of acquiring HIV from this one encounter, as an uncircumcised top, is about .62% (https://www.poz.com/article/HIV-risk-25382-5829). When you add PrEP's 99% efficacy to that number, you come up with approximately .0063% risk. You were literally at more risk of getting hurt crossing the street in Bangkok than you were from getting HIV from this experience (https://www.bangkokpost.com/learning/work/738124/thailand-roads-second-deadliest-in-world-un-agency-finds).

I am sorry you were given such inaccurate information at the Bangkok hospital about PEP. That is completely unsound advice. The science actually tells us, "When taken daily or near daily, PrEP is highly effective for HIV prevention in persons with repeated HIV exposures; therefore, initiating a PEP regimen is not indicated in people who are adherent to their PrEP regimen." https://academic.oup.com/ofid/article/2460270/Integrating-Antiretroviral-Strategies-for-Human

As far as the sore throat, swollen glands, and mild fever, only a medical professional in person could tell you what that's about. But I can tell you that it would not at all be unusual to experience those symptoms from the anxiety of seroconverting (becoming HIV positive). It quite common for people who are HIV negative to develop somatic symptoms of HIV seroconversion while they are worried about becoming HIV positive, even when there has been no risk or exposure. Our minds are more powerful than we know, and quite capable of creating physical reactions to emotional fears (https://www.psychologytoday.com/articles/201701/when-the-body-speaks). In absence of a medical diagnosis, or even in addition to one, I would invite you to consider working with a qualified therapist in your area who can help you unpack the trauma and devastation HIV has had in your life.

This article, written by an HIV nurse specialist, also specifically describes "AIDS Phobia" and how that anxiety can manifest in the body. This can occur as result of trauma after losing people to AIDS, as well as guilt or shame around one's own sexual desire and pleasure. I encourage you to read more about this in order to consider ways that you can be available to sexual intimacy with joy, pleasure, confidence, relaxation (https://www.verywell.com/understanding-aids-phobia-48745).

If you do join the Facebook "PrEP Facts" group, you'll find as well that you are not alone in these struggles, but together we are finding ways to learn to be proactive, responsible, and empowered about our pleasure and protection (https://www.facebook.com/groups/PrEPFacts/).

I hope this helps. See you on Facebook!



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