This PrEP-ed Life: Damon Jacobs on Sex and Dating in a New Era of HIV Prevention
May 13, 2013
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.
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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