For a drug that’s proven to prevent the transmission of HIV, the topic of PrEP is a divisive one for the gay community. Some think it will ruin us and we should all just wear condoms, others think it’s not the responsibility of the NHS to provide it – and then there are those who are morally against it as it “makes us look promiscuous and gives gays a bad name.”
I think a large part of the reason some gay men are against PrEP is a miscommunication about what it is, what it’s for and who it’s for. Which I will attempt to address here in a simple, easy to read format with no long words. Because I don’t know any.
Myth 1: PrEP is for everyone
The way some critics talk you’d think PrEP is going to be a compulsory government sanctioned medication, forced down the gullets of unsuspecting gays by armed PrEPstapo as they queue to get into G-A-Y Late. This, of course, is not the case. PrEP isn’t and shouldn’t be for everyone. It should be made available to those most at risk, who can’t afford to pay for it themselves and whose condom adherence is perhaps not always 100% (for whatever reasons).
A person who always uses condoms, goes for regular sexual health check-ups and whose only association with condomless sex is watching porn, is unlikely to need PrEP. An assessment will be made by a sexual health professional before PrEP is recommended. Not forced upon them. Recommended.
Myth 2: PrEP is a licence to bareback
Now we have PrEP, why bother with condoms? Burn them. Incinerate them. Gather them all up and throw them on a bonfire. Save a couple for a water balloon fight. Obviously I’m only kidding, that would be idiotic. Condoms are still vital as they can protect against a myriad of other STIs and should still be used as part of a wider safer sex armoury. Organisations like GMFA always advise using condoms along with other safer sexual health strategies, which include condoms, regular testing, education about HIV and viral load, condoms, communication, condoms, what to do in an emergency (PEP) and condoms.
Myth 3: PrEP users are sluts
First of all, don’t slut shame. Second of all, PrEP isn’t just for single people who are at high risk. What about people in mixed HIV status relationships? What about women who feel like they can’t demand condom use? What about people in relationships where their partner is living with HIV but is not undetectable? It’s a mistake to make sex a moral issue where people who bareback are the bad people; it’s about getting people to engage with sexual health services, providing them information and empowering them to take control of their sex lives with the different HIV prevention methods available.
Myth 4: PrEP is too expensive to be made available on the NHS
The cost of PrEP as a HIV prevention method is actually cheaper than the lifetime healthcare costs of someone living with HIV. In the long term, every case of HIV that’s prevented will save the NHS money. Not forgetting the fact that PrEP won’t be compulsory – all gay men won’t be forced to take it. It will probably only be made available for those at high risk. And quite honestly, can we really put a price on preventing someone from having to cope with a lifelong illness? The answer to that question should be no. Also it was rhetorical.
Myth 5: PrEP is a magic pill that solves everything
Nope. No. It’s not. It does prevent HIV infection, which is pretty wondrous in itself, but it’s not that simple. You’ll need to go for routine check-ups and blood tests every three to four months, as well as kidney function checks. But that’s only mandatory if it’s available on the NHS. You can buy PrEP unmanaged now online, when really the NHS should get people to engage with sexual health services and monitoring PrEP adherence (you can’t miss a dose!) and its impact on the body.
Myth 6: All you need to do is take PrEP, other safer sex methods be damned
We hear this bandied around a lot. “Sexual health organisations just want gay men to go on PrEP and use nothing else” or “They only care about HIV.What about other STIs?”. PrEP is and will always be promoted as part of a wider safer sex armoury, which includes condoms. Condoms are still important. Condoms will protect you from a whole host of other STIs. However, occasionally condoms can fail. But imagine a world where you’re using both condoms and PrEP – it’s double protection, like a car with seat belts and airbags or…deodorant. I’m having an analogy mind-blank. I do acknowledge that organisations and charities like HERO have focused on campaigning to make it available on the NHS and less about the virtues of PrEP and how it will actually be applied. But here I am doing it now… so there.