In late May, the U.S. Centers for Disease Control and Prevention (CDC) announced updates to its guidelines for prescribing pre-exposure prophylaxis (PrEP), a drug that, studies show, reduces the risk of acquiring HIV through sex by 99%. That’s good news because those guidelines have not been updated since 2017. The previous update occurred in 2014, the same year that I tried and failed to receive PrEP on six different occasions.
At that time, any doctor I spoke with told me that I did not need PrEP because I was in what I thought was a monogamous relationship. In their own way, each PrEP navigator or doctor with whom I spoke advised that if I doubted my partner’s fidelity, I should break up with him.
Taking a moment to ignore the fact that my sexual relationship was no one’s business but my own, what troubles me most about those interactions is that when I sought help, numerous medical professionals ignored their duty to protect my health and chose to violate my wishes due to their biases about who PrEP was meant for. “You don’t want to be a Truvada whore, do you?” one doctor asked me, using a pejorative term used to describe people who eschewed condom-based sexual protection in favor of natural sex.
Those physicians’ decisions to judge me may have been wrong, but they were also in line with CDC-administered guidelines. At the time, federal guidelines recommended that “PrEP be considered for people who are HIV-negative and at substantial risk for HIV,” according to a May 14, 2014 article from TheBodyPro.
That included anyone who was in an ongoing relationship with an HIV-positive partner, as well as anyone who 1) was not in a mutually monogamous relationship with a partner who recently tested HIV negative, and 2) was a
- gay or bisexual man who had had anal sex without a condom or been diagnosed with an STD in the past six months; or
- heterosexual man or woman who did not regularly use condoms during sex with partners of unknown HIV status who were at substantial risk of HIV infection (e.g., people who injected drugs or had bisexual male partners).
Not the Worst Thing That Can Happen
My partner at that time and I had only stopped using condoms after we both tested negative for sexual infections—twice, at my insistence. And though I trusted him, I still believed that taking PrEP was a smart idea. It annoyed me that every doctor with whom I spoke disagreed and told me that “responsible people like you don’t get HIV.” I knew this wasn’t true. One of my best friends discovered that she was living with HIV after receiving a blood test before her wedding. I knew that was a fluke, but it still weighed on my mind. Nevertheless, I acquiesced to my doctors’ rationales and gave up my pursuit of a PrEP prescription.
Thirteen months later, while escorting a friend to his yearly STI test, I tested positive for HIV and discovered that my relationship was not as monogamous as I had thought. It was the day before my birthday, and all I could think was, “At least I’m not a Truvada whore.”
At the time, I was angry because I felt like the tragic statistic that society expects of Black gay men. Though I’ve overcome that personal disappointment by realizing that my life is still awesome, I’m still happy and encouraged to know that the guidelines that pushed all sorts of unnecessary angst onto my life are being revised to protect people from seroconverting.
For Anyone Who Has Sex
Being diagnosed with HIV is not the worst thing that can happen to a person, but that does not mean that I want anyone to have to deal with the nuisances and stigma that accompany the virus.
Under the new federal guidelines for PrEP—which should be implemented this summer—the CDC has recommended that all sexually active persons, both adults and adolescents, receive information about PrEP from their doctor or other health care provider. Built within this new approach is the study-reinforced understanding “that patients often do not disclose stigmatized sexual or substance use behaviors to their health care providers (especially when not asked about specific behaviors).”
This new method still requires that doctors discuss a patient’s sexual-health history, but it also acknowledges that some patients may “not feel comfortable reporting sexual or injection behaviors to avoid anticipated stigmatizing responses in health care settings” and that “for this reason, after attempts to assess patient sexual and injection behaviors, patients who request PrEP should be offered it, even when no specific risk behaviors are elicited.”
In other words, even if patients do not reveal the full scope of their sexual or drug-use history, under CDC’s new proposed guidelines for PrEP, they will still receive information about as well as a prescription for the drug should they request it.
If these guidelines are implemented, we can expect to see a revolution in protecting Black women—who are largely ignored by HIV-prevention efforts—and other at-risk communities from the virus. The assumption will no longer be that HIV is “a gay disease”; rather, HIV will be treated and discussed much like any other disease.
In the words of Whitney Sewell, Ph.D., M.S.W., a postdoctoral fellow at the Department of Population Medicine at Harvard Medical School and Harvard Pilgrim Health Care Institute who specializes in disseminating information about PrEP among Black women, this will allow doctors to tell their patients, “Because you are someone who has the opportunity to expand into different types of sexual lifestyles by your choice, it’s my obligation as a provider to provide [you with] educational resources.”
In addition to expanding the full range of health services that patients receive, this will open up the potential for more honest conversations between doctors and people within their care.
If my doctors had been willing to have those conversations with me six years ago, I would have a completely different life today. I am happy that the CDC has finally caught on and recognized that instituting policies based upon collected behavioral data alone—without considering that people will not always feel comfortable with telling the whole truth to organizations that are ruled by unequal power dynamics and stigma—leads to negative health outcomes.
But just as importantly, I am thrilled that the CDC has recognized that its previous guidelines left many people without recourse or protections if the truthful information that they provided failed to fit the outdated profile of who was at risk for seroconverting.
Anyone who has sex or injects drugs can acquire HIV. For that reason, anyone who requests PrEP, for whatever reason, should be given a prescription without judgement—especially if the United States wants to end the HIV epidemic by 2030.