We live in a culture that is dominated by sexual influence, however, there’s an inherent disbelief and lack of understanding in the ways in which we can protect ourselves and how we conduct our sexuality within the gay community. Around six years ago, a drug known as PrEP was introduced into Australia. PrEP, known as pre-exposure prophylaxis, is a drug usually taken once a day, which helps to combat and secure protection against HIV. While not a be-all-end-all, the drug is an extra benefit in helping to protect the recipient, however, there’s still a whole culture out there that are finding themselves unsure and uneducated on the drug and how it can benefit the community at large. To get a better picture of the issue, we’ve spoken to three young, gay men whose experiences with the drug have brought invaluable insights into its use.
PrEP is widely unknown to most of the general population, having only been added to the Pharmaceutical Benefits Scheme (PBS) around seven months ago. However, within the gay community, there’s been a boom in knowledge of the drug itself, but not exactly the effects. Michael Traeger of the Burnett Institute, a non-government, private research institute of which Traeger and his team work within STI surveillance, states, “We’ve managed to capture the inner urban, middle class gay population. And the uptake in that population is high. But we’ve seen in the last 6 months to 12 months in terms of new HIV cases, it’s kinda shifting.” While gay men in metropolitan areas are finding themselves better educated and with easier access to PrEP, Traeger has found HIV rates within Asian-born gay males, injecting drug users, and even the heterosexual population have increased without access to the right information on preventing sexually transmitted diseases. “It’s not so much about increasing awareness, but making sure we’re increasing awareness in the right places.”
“PrEP has shown to be over 99% effective when taken correctly and every day.” – Michael Traeger
Published earlier this year, a study from the Williams Institute in the United States found that there was a higher factor of young men not taking the medication due to their lack of access to LGBTQ+ health clinics and organisations, their sexuality or living situation, leaving only a staggering 4% of sexually active gay and bisexual men actively taking the drug. There’s a clear distinction between what constitutes adequate education and the reach that it has. The study continued to highlight the difficulty in which young men in the queer community were receiving annual HIV tests, with only 25% of young gay men failing their required testing compared to only 8% of older gay men. Lead author, Phillip L. Hammack, Ph.D. contributes the low testing levels in the younger generation as a direct link to the lack of knowledge about the AIDS epidemic. “I worry especially about younger men who didn’t grow up with the concerns of HIV that men of older generations did. The low rate of HIV testing probably reflects a degree of complacency and cultural amnesia about AIDS.” However, through the release of the study, Hammack attests that a continued investment in queer resources over the years has led to our best bet against HIV.
Although, Robbie van Dijk, a 25-year-old gay man, and board member for Minus 18, who’s taken PrEP for many years, believes there’s a wealth of information that hasn’t been made as accessible as it possibly could be. “Definitely promoting it more or just providing more access to information, so that people are more educated [on PrEP]. I mean, there’s still some ignorance around what it is, what it does, and what it’s for.” He believes taking more action in helping people gain access to all the information and its benefits would be helpful for the community. As someone who was relatively high-risk when he started taking PrEP, Van Dijk acknowledged that taking the drug became a sort of security blanket for those who were in the same position. “I was already engaging in relatively risky behaviour in my sexual life, so this was just, I guess, a sigh of relief.“ With the knowledge at hand for what PrEP could do as an extra layer of protection, it allowed Van Dijk to feel safer in his sexual life, something of which the gay community as a whole should be afforded.
Not only would this allow for a better understanding of sexual health, but it would confront strong stigmas within the gay community that, while eroding over time, are still significantly affecting how gay men perceive each other and themselves when taking PrEP. Van Dijk highlighted the perceptions people have against each other, with people often assuming that taking PrEP makes you a ‘PrEP-slut‘, or that guys ‘just want to be sluts and have bareback sex‘. These stigmas are dismissive of what is a momentous remedy for the gay community at large. Slinging such slurs around the community detracts the clear strengths of the drug and instead brings harmful connotations to mind.
Vinnie Barbarino, a 23-year-old gay man, who was one of the first trial recipients for the drug, noted that the stigma behind it damaged the relationship between his then-boyfriend, who believed it would lead to him sleeping around. After their fraught relationship, Barbarino was able to convince his partner to come around the idea of PrEP, however the damage had already been done. Breaking down these stigmas would lead to a better understanding of the drug itself and its positive effects. While it took Barbarino 8-9 months to land a place on the trial, he doesn’t regret the process and the subsequent aftermath. “I thought it would be smart to know that even if one time we did anything and we forgot to wear a condom or whatever, at least we know we’re both going to be semi safe.”
As another prevalent example of stigma on the PrEP drug, there’s a strong opinion amongst the gay community that if one uses the drug, condom usage is no longer important. Barbarino states that while he doesn’t condone not using condoms, “…not gonna be lying if I said no [to a reduced use in condoms]. It has obviously made it a little bit easier for when that one time a guy says I’d rather go raw, you kind of think, oh alright.” Many gay men in the community are starting to find themselves relaxing on extra preventative measures with the introduction of PrEP, especially now it’s on the PBS. While in Australia, rates of HIV are decreasing, there’s been a debate for the past five or six years have on whether or not PrEP has led to a reduced use of condoms. Research released by Professor Martin Holt at the University of New South Wales, Sydney, supported the idea that people regularly using PrEP are more likely to decrease their use of condoms. Over the course of 2013 to 2017, regular condom use between men who have sex with men decreased from 46 to 31 percent, and a lack of condom use during anal sex rose from 1 to 16 percent.
Taking a look at PrEP’s effects on STI rates within the community, the Burnett Institute recently published a meta-analysis, in which they found that starting PrEP lead to an increase in STI’s at an individual level. However, Traeger states, “We’ve also done an analysis of the PrEP X study, looking at about 1500 people from before they were on PrEP to after,” concluding that, “We’ve had about a 20% increase in STI rates. But, it’s important to understand that when people start taking PrEP, they also get tested more frequently, so you’re more likely to detect STI’s anyway.”
“Since PrEP came in, both people taking PrEP and people not taking PrEP feel more comfortable with condom-less sex.” – Michael Traeger
Yet some of the biggest hurdles to overcome allowing for access of PrEP to gay individuals harkens to the roles in which general practitioners prescribe the drug to their patients. Since the introduction of PrEP to the PBS, GPs across the country are finding themselves still hesitant to prescribe the drug to their queer-identifying patients, leading many patients to seek refuge in local Sexual Health clinics in order to receive the prescription they need. Traeger attributes this to the possibility of a “lack of knowledge and lack of working with the community.” He’s found that since GPs may not receive the best information on the drug or don’t have much interaction with gay patients there’s even been cases of patients describing PrEP and how to prescribe it to their GP themselves. While the Australian Sexual Health body has dedicated itself in educating GPs on PrEP, for the present moment, most people will continue to turn to sexual health clinics in order to obtain the correct prescription.
This isn’t the only hurdle still to jump, there’s still an issue of affordability of the drug which has been known to range in the hundreds of dollars each month, causing many people to find alternative routes in order to obtain their prescription. Website PrEP Access Now has found popularity within the gay community, helping to find alternative ways in order to afford the drug. The site lists the different brands of PrEP and the prices that range from $20-$70 monthly on a three-month prescription, which are then shipped from overseas, making it a lot easier for people to gain access to the drug. PrEP Access Now also allows the community to also find a multitude of ways in order to access cheaper options, featuring coupon, studies and a Facebook page in which you can participate that could help lower costs.
Since taking part in the trial, Barbarino only pays $32.50 a month for his prescription, and notes that the cost of PrEP outside of the discount supplied to him through the trial would possibly force him to stop. “It’s an expensive drug to go on, so if I was ever put back onto full price, I’d probably stop taking it, which is probably bad for me to say.” Without the discount afforded to trial subjects, people in the community are decidedly looking into smarter ways to avoid paying over-the-top prices. Outside of Australia, affordability has taken a toll on the accessibility of the drug and the number of users. Since the drug was approved by the FDA in 2012 in the United States, only 10% out of 1.2 million of citizens who would benefit from PrEP have been regularly using it, with Truvada, the only source of PrEP in the country, costing around an average of $20,000 a year.
Outside of PrEP Access Now, people have taken action into their own hands, finding more options in which they can connect others to alternative ways in which to stay protected, while also keeping you fully informed. Ending HIV 2020 is a campaign that helps connect young men to all the information they need in order to be safe. The site connects users to information on testing, STI’s and HIV, places to get tested and ways to book in, ways to access condoms, as well as a risk calculator that helps the user find the risk associated with various sexual tendencies. While PrEP remains a vital tool against HIV, this campaign is an important way in which to keep people engaged in alternative issues which are just as, if not more so, detrimental to the overall sexual health of the community.
While awareness in the queer community is increasing as more and more outlets open up, there still remains a stigma that has grown within the world at large, which sees HIV as a gay male’s disease. However incorrect this assumption may be, the world is behind on fully acknowledging the damaging affects it has on all sexually active people. Comparing the use of PrEP from the queer community to the straight community, there’s a difference that remains steep. There’s a very low level of people within the straight community that are using PrEP on the regular, vastly outnumbered by the queer community. While, studies have found that HIV prevalence is higher within queer individuals, over the years heterosexual people have found HIV rates increasing. “In the Australian sexual health guidelines, it’s not really recommended for straight people.” Traeger states, “It’s only recommended for people who are considered high risk or medium risk, and if the fall in certain categories.” Without a targeted campaign for heterosexuals we could see the number of HIV levels failing to decrease over time, something of which is damaging.
“Access to education for straight people as well because there’s still, and I think, always will be that stigma that HIV is a gay man’s disease.” – Robbie van Dijk
Taking a moment to point out a vital aspect in HIV-prevention, Traeger, Van Dijk and Barbarino were all in agreement that the most important thing for the gay community as a whole, is to be as fully informed as possible. Traeger, who’s about to embark on a PhD in STI surveillance in PrEP users, notes that, “Your peers and community organisations are the best source for information,” and if all else fails, to keep on top of your annual check-ups. “It all falls apart if everyone starts taking it, and they’re not taking it properly or they’re not getting tested. So just monitoring those things will be really important.” And for this, I have to concur.
Taking a look back at PrEP and its influence, it’s become abundantly clear that the importance of the drug shines within not only the queer community, but across the world. PrEP may not be for everyone. It is not the perfect be-all-end-all solution, and it is unfortunately riddled and projected with tightly-held social stigmas. However, what makes for a strong case for PrEP is its important role to play within the prevention and hopeful destruction of HIV in the future. Providing easier contact information and general access to the drug would be highly beneficial in allowing for safer sexual experiences. Through the use of websites such as PrEP Access Now and Ending HIV 2020, we owe it to ourselves to keep updated on this issue, of which its education should be extended to schools and communities outside of the general urban population who might otherwise have not heard of the drug. Now’s the time for you and those in your community to keep yourself informed and decide whether you believe PrEP is right for you. Regardless of sexuality, gender, or societal expectations, your sexual health matters and it’s your right to play it safe.
For more information on PrEP and it’s effects please follow the Ending HIV 2020 website, here.
For alternative ways in which you can resource more affordable or alternative PrEP, click here.