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This PrEP-ed Life: Damon Jacobs on Sex and Dating in a New Era of HIV Prevention

May 13, 2013

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As a licensed therapist working with people living with HIV, Damon Jacobs heard about pre-exposure prophylaxis (PrEP) as an HIV prevention strategy. When he found himself newly single after being out of the dating game for almost a decade, he re-entered a dating pool that was not at all condom-friendly. To deal with this, and to finally come to terms with his distaste for condoms, Damon began taking PrEP in July 2011 to stay HIV negative.

Now, almost two years later, he's never missed a single dose -- and he's become an advocate for education around PrEP, though he acknowledges that it may not be the right strategy for everyone. From dispelling myths around anti-condom attitudes to advocating that people be able to talk to their doctors about all aspects of their sex life, Damon reminds us that sex isn't dirty, and we can have sexual pleasure, but we have to be smart and know our own bodies.

Inspiring stories of people living with HIV.

Can you tell us a bit about your background and experience in the HIV community?

I'm a licensed marriage/ family therapist in New York state. I'm also licensed in California. That means that I work with people in relationships. Sometimes I work with couples in the room. Sometimes I work with individuals who are in couples.

I was getting my formative education and training in psychology in the San Francisco Bay Area in the mid-early 1990s, in the early days of HIV/AIDS -- or, actually, it was after the first wave. That was a time when loving people with AIDS and knowing people with AIDS meant losing people with AIDS. You would see people one day and then the next day, you wouldn't see them. That was before we had treatments. And that really affected a lot of the way that I continued to want to be active in the HIV prevention, education and treatment community -- also as a therapist, as someone who could help people infected and affected by HIV to have lives that were still meaningful and purposeful and pleasure-filled.

That's really been the mission that I've had for the past 15 to 20 years, is trying to promote a sense of empowerment, and mental and spiritual health for people infected and affected with HIV -- people that are, often, in relationships with other people who are HIV positive, and a lot of serodiscordant relationships (meaning that one person is negative, one person is positive) -- and helping them negotiate the boundaries and agreements and how they discuss issues around sexuality, around sexual expression.


When was the first time that you remember hearing about PrEP?

The first that I remember hearing about PrEP was actually around Thanksgiving, the day before Thanksgiving, of 2010. I try to keep up with the latest research, and I had just heard about this study. I didn't really know anything about it. I just heard that there was this study called "I-Something." I thought it was like an Apple computer or something, because it was called the "iPrEx study." I heard about some sort of pill that could potentially prevent someone who was negative from becoming positive. And I thought, "Well, that could be interesting." Then I didn't really think any much more about it for another six months.

During those six months, a long-term relationship of mine was coming to an end, and I was getting back into the dating world. Also, the cruising world. I realized that in the seven years that had passed since I was last single, a few things had changed. For one thing, the partners I was meeting had a very different attitude around condoms than they had had in the early 2000s. They didn't want to use condoms. And to be honest with you, there were times I didn't want them to use condoms, either. For the very first time in my life, I was in this confusing state of, "Wait a second, I've been this prevention advocate about condoms and lube for all these years. And here I am, not exactly holding myself to the same standards."

So, I heard about this information session about PrEP that was going to be happening at GMHC in about June of 2011. And I thought, "Well, I just want to know more about this." I didn't think it was going to apply to me in any way. But when I got there, there were some of the researchers and some community advocates that were sharing the information that was available. And when I heard the researchers say that the variable aspects of efficacy in the iPrEx study ranged from 44 percent and 90 percent ... well, 44 percent wasn't going to sell me. I wasn't going to play that game. But when I heard that it was 90 percent amongst participants in the study who actually took the medication consistently, between 90 and 92 percent, that's when my ears perked up. I was like, "Wait a second, maybe this is something for me. Maybe this is something that would not only positively impact the people who I work with and my friends and my clients, but maybe this is something I would benefit from." Again, I was having a much more difficult time maintaining the consistent use of condoms than I had had before. Realizing that there could be a medication that could actually assist me in maintaining my HIV-negative status by about 90 to 92 percent made me want to learn more about it.

I talked to the researchers, and I got some of their information after this event at GMHC. I then learned more about the iPrEx study, and by that point the CDC (U.S. Centers for Disease Control and Prevention) had a page on their website for doctors to go to if they wanted to prescribe this as an off-label medication, because it was not yet approved by the FDA (U.S. Food and Drug Administration) at this point. It would still be a year away before the FDA would approve it. But there was still plenty of information about the iPrEx study and information and guidelines for doctors -- even in 2011.

So, I printed all that out, took it to my doctor, who I have a very good relationship with, and said, "Look, this is what I'm learning. This is what the research is saying. And, I'm having a harder time in my early 40s staying safe than I ever had in my 20s or 30s. I think this might be the right thing for me." He looked it over, he thought about it, and said, "Yep, I agree with you." That's when I started PrEP. I started July 19, 2011, and I've not missed a single dose since. We are now in March of 2013.

What I've since learned and what I've become more knowledgeable of, what we've become more aware of, in the time since the iPrEx study, is that the participants who took Truvada (tenofovir/FTC) seven days a week -- who did not miss a dose -- appeared to be 99 percent less likely to contract HIV. The original estimate that they were putting out there was around 90 to 92 percent. Maybe it was always known, or that knowledge was not made readily available, that that subsection of the 2,500 participants who took this seven days a week appear to be 99 percent less likely to get HIV.

Now, condoms, which I've relied upon to stay negative, despite having positive partners, despite having positive boyfriends, which I always have, those are about 98 percent effective. So I knew when I was being sexually intimate with a positive partner with condoms and lube, there was 98 percent protection, and I could work with that. With PrEP now, with 99 percent efficacy -- if taken everyday -- wow. Wow. Revolutionary.

It confuses me why more people don't know about this. It may not be the right decision for everybody. For me, I really had to think about it from a medical perspective. From an emotional, sexual perspective, I had to think whether this was the right choice for me or not. But, the fact is, it has been approved by the FDA for this use since July 16, 2012. And the majority of the people I know, the majority of the people I talk to, don't even know it exists, much less that it has been approved -- and that many insurance companies pay for it. It baffles me how we can have such an effective tool in the fight against HIV and so little information out there about it.

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This article was provided by TheBody.

Reader Comments:

Comment by: sumannaik (INDIA) Tue., Sep. 24, 2013 at 9:59 pm UTC
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Comment by: Craig Allen (Raleigh, NC) Sun., Sep. 8, 2013 at 11:23 am UTC
Just so you know, when you're talking HIV+ people who are in the habit of using condoms out of using them because you are one single case in which you have money and insurance and know PrEP is being taken correctly, does, in fact, make you part of the "bareback brigade" who is actively breaking down the habit of HIV+ men wearing condoms when they top.
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Comment by: mary soilex (los angeles, CA) Tue., Aug. 13, 2013 at 11:29 pm UTC
Und what about women takin this? yus did not mention that. We have sex mit bi sexuals und straights who may be positive. So why not mention women? Can we take it? Please inform. Thenx.
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Comment by: Joshua M. (Culver City, CA) Tue., Jul. 23, 2013 at 8:24 pm UTC
Congratulations Damon for not only discovering a 99% effective protection against contracting HIV while enjoying bareback sex, but also for managing to take advantage of a widely-viewed forum to convey this astounding message to those of us who are deeply and passionately condom haters! Your interview is just amazing, truly uplifting, and empowers those of us who have been unwilling to forfeit the profoundly passionate, incomparably sensitive and rapturously intimate joy of skin-on-skin intercourse to also take hope that we can now depend upon having the same degree of protection as those who shroud their manhood in a plastic burkha. The advice and information you present is welcome and valuable and as someone who rarely clicks to start a video interview I must admit that I actually expected another downer report intended to strike guilt and fear in those of us who, from years of fighting the battle, have become inured to those warnings.

One of the points you mentioned which particularly captured my attention was when you mentioned the subset of men in their 50s who think “…at this point in my life I’m going to die from something else, so why not, who cares about HIV.” I happen to be someone approaching that age and it had never entered my head that my 50s, or even my 60s, would be the time to throw in the towel. Who are these guys? It sounds like they’re suffering from Major Depression—which can also be alleviated by an oral medication.

Anyway, just let me say that it seems we’re finally reaching the point, as a community, where we can appreciate and respect one another whatever their personal choices may entail. I know I’ve been lucky depending on the word of my partners to protect me during raw sex (especially since I’m a bottom). Now though I won’t even need to “pop the question” but instead just “pop the pill.” Awesome!

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Replies to this comment:
Comment by: Damon L. Jacobs (New York) Mon., Aug. 5, 2013 at 5:29 pm UTC
Thank you Joshua! I appreciate your words. Although there is a pattern for some men in their 50s to give up condom use (without PrEP), I caution people from assuming it is a symptom of Major Depressive Disorder. We generally don't question the mental state of straight men who choose not use condoms. I'd say a lot of the times it simply "condom fatigue."

BTw - I'm from Culver City!

Thank you commenting... Damon

Comment by: Bob Skinner (Corvallis Oregon) Tue., Jul. 23, 2013 at 6:27 pm UTC
Bravo Damon, Thanks so much for reporting on this. As an HIV/AIDS educator I am frequently asked about this and how I feel about condom vs. a pill. At first I though it was just a way that the medical community was just using as a way to fill in the gaps of somewhat failed prevention messages. I know better now. As we now know PrEp can be very effective if taken correctly just like other ARV treatment. Thanks for getting me excited about this and keep up the good work !
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Comment by: J. Silverstein (Chicago) Fri., Jul. 12, 2013 at 2:15 pm UTC
I find this article "very" interesting. However, I do have a couple wee comments...
Aids/HIV is obviously a global issue to us all on this planet(republicans) not included. Sorry, mate just a bit of tongue and cheek! Right, back to my point. Many of my straight mates are every bit as... free with love as "WE" are, therefore shouldn't this article focus on what the drug can and would do for both gay and straight individuals? Its simply daft to mention the "party" components of this drug when compared to its obvious life saving upside. People will abuse it or rather use it for other issues whether there is actual education about its proper use or not. Before, I get flamed by some clever sod let me address the 800lbs elephant in the room...Yes, if we all were 100% monogamous there wouldn't be as big of a need to adhere to this drugs proper use now would there? But, "WE" all are people with feelings and needs whether "gay or straight". Ignoring one's emotional/physical needs is just folly and not at all living in reality. If I was doing the PR for PreP I'd try to appeal to "ALL" people not just us brilliant gays. Aids/HIV after all doesn't give one single toss about who we humans fancy having a shag with--now does it? Loved your piece mate;-)! Cheers.
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Comment by: Damon L. Jacobs (New York) Mon., Aug. 5, 2013 at 5:39 pm UTC
Hi J. Silverstein

-- Love your accent!

You are absolutely correct in asserting that PrEP education and information would ideally be targeted to EVERYONE who could be at risk. At the same time, 78% of new HIV infection rates in the U.S. are still occurring through M2M contacts. I would love to see women getting on board with this as a health issue.

Comment by: n. van der bergh (South Africa) Sun., Jun. 2, 2013 at 4:23 pm UTC
Dear Damon,

When you decided to utilise PrEP, was it only Truvada or Truvada and condoms?
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Replies to this comment:
Comment by: Damon L. Jacobs (New York ) Mon., Jun. 3, 2013 at 4:17 pm UTC
Hi N. Van Der Bergh -- I have used both, depending on partner's preferences. Some people still prefer using condoms, and that is fine. Truvada is "A" strategy for prevention, not "THE" strategy. It is one of many tools, which includes condoms.

Comment by: Tom (Orlando) Wed., May. 29, 2013 at 5:06 pm UTC
Will you stop demonizing the AHF? The ONLY application for this pill is for recreational, and Weinstein deserves kudos for being the only person in the HIV community who said so and is still standing. PrEP is not going to stop the spread of HIV, it's not going to limit stigma, and it's sure as heck not going to make things better for anyone except the party crowd. The nonstop advertisement for a recreational drug on supposed educational sites has got to stop. It's a public health disaster waiting to happen, and everyone knows. Give it a rest, the entire world is rolling it's eyes.
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Comment by: Damon L. Jacobs (New York) Sun., Jun. 2, 2013 at 12:13 am UTC
Hi Tom,

I, for one, do not demonize the AHF. PrEP is not only used to enhance intimacy, but it is also being used as a prevention strategy by individuals in violent relationships who cannot (for various reasons) leave. It is also being used by sex workers to reduce safety risks. These groups may not be as public as I have, but one could reasonably say their use goes beyond "recreational."

PrEP is not going to stop the spread of HIV, but used effectively it could sure slow it down. We haven't seen any significant drops in new HIV infections in the U.S. for the past decade. PrEP could change that if it was widely known about and available.

In a sex negative paradigm, risk reduction and protection will always be a source of stigma and shame. Women have been dealing with this for decades in regard to having accessible birth control and abortion rights. We can all learn a lot about from Feminism about how to stand up for rights to express oneself sexually with a partner - even under the threat of misogyny and hate.

Comment by: Joel (Houston, TX) Tue., May. 28, 2013 at 10:21 pm UTC
Damon, thank you for telling your story. One of the saddest parts of this epidemic (besides the millions that have died and the fact that it didn't have to happen) is the cruelty and discrimination in our own community. As someone who is educated and who does not consider status when deciding who to date and who to love, I think the truth about this drug must finally be told. But it cannot be told without telling the story AHF and Michael Weinstein, who railed against the makers of Truvada and said that it would be a bareback festival, if approved. That did NOT happen, according to studies and the drug has proven very effective. Thanks again, Damon. Maybe our community can stop acting like Rick Santorum when it comes to people living with HIV/AIDS.
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Comment by: Damon L. Jacobs (New York) Sun., Jun. 2, 2013 at 12:06 am UTC
Thank you Joel!! With ya 1000% !!

Comment by: WH (Hartford, CT) Sun., May. 26, 2013 at 6:42 pm UTC
What you don't mention is who is paying the expensive cost of this drug? I doubt any insurance coverage would cover something deemed "preventative" in this set of circumstances. By not disclosing that financial reality the article is incomplete.

Hiv+/Undetectable and 6 years strong on Truvada/Kaletra regimen. I know the issue of viral resistance - my initial diagnosis and viral analysis indicated I was one of the "lucky" that got the double whammy - diagnosis and the 25% that are infected with a resistant strain, most likely due to non-adherence by a patient on meds.
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Comment by: prep taking in community (anywhere?) Wed., May. 29, 2013 at 11:27 am UTC
hi there, he talks on the first and second pps of the article about insurance companies. that looks like his insurance pays for it. my insurance pays as my doc prescribes as i am a person at risk.
Comment by: Damon L. Jacobs (New York) Sun., Jun. 2, 2013 at 12:05 am UTC
Hi WH - As of yet, no one that I know has been denied access to the drug through their insurance. In New York, the state Medicaid system now pays for it due to the efficacy. My understanding is that Medicaid is paying in other states, but not making a public pronouncement about it. Gilead has pledged to make it available through their Assistance Program for those with no means. One person I know has received it that way as well.

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