Truvada: A Better Choice, But Not an Excuse

The following article contains information about Truvada® and other prophylactics. Opinions expressed in the article are that of the author and do not necessarily reflect the opinions of GayFresno, its owners, entities, and subsidiaries. The information given is not an attempt to practice medicine, and all medical information is documented with the American Medical Association, Truvada®, the Centers for Disease Control, and California Board of Medicine. You should always seek the advice of a licensed medical practitioner when making decisions about your health.


Back rooms, parking lots, bath houses… A club a here; an alley there. It was the 70s. The era of free-love and sexual liberation…for some people. For the gay community, there was nothing liberating about it. Even though Stonewall had pushed the LGBT community into the public eye in 1969, its members were a long way from finding acceptance. We were living in a time where people were making gay synonymous with pedophile. Being in the closet meant living in the closet. While Anita Bryant’s fame and fortune were fueling a growing hatred for our little sub-population, Harvey Milk was fighting to set us free and give us hope. But regardless of the political climate and media uproar, one thing remained constant…the need for human contact.


Was it all about sex? No, it never has been, but the reality is, when there are so few of us…when so many of us were living hidden, it made finding relationship partners difficult at best, and many people turned to discrete meetings in shadows or seizing an opportunity when someone like them expressed an interest. Condoms weren’t readily available, not like they are today. Chance sexual encounters didn’t always give you the opportunity to “prep.” Hell, they barely gave you an opportunity to get your pants down. (I guess some things never change.) People were throwing caution to the wind. I’m sure there were some who played it safe, but most people…they just took what they could get when they could get it. And why not? There was no concern for pregnancy, and at the time, most sexually transmitted infections and disease could be cured with antibiotics or treated with a reasonable degree of success. Nothing was really life threatening. But then, in the summer of 1981 something new stepped into the light… HIV made the headlines. The New York Times ran an article titled “Rare Cancer found in 41 Gay Men” and by the end of the year, 121 people were known to have died from the disease inside the United States. The numbers kept growing, and the mystery disease kept spreading. In 1982, the first case of blood transfusion infection popped up. In 1984, Ryan White was diagnosed with HIV from Factor VIII, a medicine used to treat hemophilia. Numbers were growing. People were panicking. It had become an epidemic. In just 5 years, the casualties of the AIDS-crisis had moved from 121 infections to 15,000 cases and 12,000 deaths. A decade later, in 1995 there were more than 500,000 people living with HIV/AIDS, and more than 300,000 deaths related to the disease. And here we are, in 2014…one more decade later…with 11.1 million people living with HIV in the U.S. Twenty years turned a handful into millions.



What caused it to spread so quickly? Gays? Prostitutes? God? Blame whoever you like, but the real culprit is irresponsibility. We have an obligation to each other to make healthier choices, and it’s not just about HIV. (But that’s for another article.) Indiscriminate sexual encounters are still a thing. We call them random hookups. The back alleys and bathhouses of the 70s and 80s have been replaced with apps like Grindr and websites like Craigslist. The difference is: We have an opportunity to bring the spread of HIV/AIDS and other sexual transmitted infections to a halt. We are better educated with limitless information at our fingertips. A person can buy condoms through the self-checkout lines at any number of department stores. No need for embarrassment. Grab them and go. Special lubricants reduce the risk of infection and pregnancy. And now, a new era has dawned: Truvada®, the first FDA approved pre-exposure prophylactic (PrEP.)


I want to take a moment and present some information about the drug itself. First and foremost, Truvada® is not a cure, nor is it 100% effective. It is not approved for all groups and types of people, nor is it approved for all forms of HIV. Truvada® is approved for the treatment of HIV-1 and to help reduce the risk of getting HIV-1. It is not recommended for individuals under the age of 12 or low-risk individuals. The drug carries a long list of serious side effects which include: lactic acidosis, liver disease, kidney problems, bone issues, and changes in immune response. It also includes a list of less severe symptoms such as: diarrhea, nausea, tiredness, headache, dizziness, depression, problems sleeping, abnormal dreams, and rash. Truvada® can be passed into breast milk, and it is unknown as to how it will affect pregnancy.


Truvada® is indicated for use with a comprehensive prevention program. What does this mean? It means people still have a responsibility for their health. This drug does not alleviate anyone of their obligation to make smarter, safer choices. Sexual freedom also means sexual responsibility. Please don’t think you can pop a pill and then have sex with anyone you want to as often as you feel like without risk. It simple does NOT work that way. How does it work? Truvada® is proven to reduce the risk of transmission when used with other safer-sex choices for high-risk individuals: men who have sex with other men, prostitutes, and IV drug users. It is NOT an excuse to be irresponsible. Let me say it again: Truvada® is NOT 100% effective and you are STILL at risk of infection when you make unsafe choices. When we stop and look at the numbers, they can look a bit deceptive. One study on couples where one partner was HIV-1 positive, showed a decrease in the risk of transmission at by 75% (Partners PrEP study, Truvada®). The drug was administered along with counseling and OTHER prophylactics. This does not translate into a 75% reduction for everyone. Another study showed a 42% decrease in risk in men who have sex with men when Truvada® was used with counseling and other prophylactics. Let’s take a moment and put that last study into a different situation. 


Let’s say I have 10 people put on a bulletproof vest. I show them how to use it properly. I teach them what to do in situations where they may be hit with gunfire. I step back and fire a hail of bullets at all 10. With the same odds (42%)….4 of them are going to get hit and possibly die. Would they allow me to shoot at them with those odds? I don’t think so. Now lets say that I spend some extra time showing them some other techniques. I give them a flex shield for added protection, and I limit the number of shots to 5. This significantly lowers the risk of a fatal shot by 99%. This means that 1 person out of those 10 has a slight chance of being wounded. Safer sex options, even with Truvada®, work the same way. The key to prevention is lowering the risk. Every choice you make that lowers your risk factor increases your chances of survival. Condoms, microbicidal lubricants, advice, fewer partners, and Truvada® combined give a person the BEST chance at a long, disease free life.


While I am thrilled with medical breakthroughs like Truvada®, I worry that many will see it as an excuse to return to the days of backroom “barebacking.” This drug does not absolve anyone of personal obligation, and it is NOT a license to condom-free sex. We as a community, as a population…as individuals cannot afford to throw caution to the wind. We cannot go back to indiscriminate sex with random strangers and expect to eradicate the pandemic that is HIV. We must remain vigilant. We must make safer choices. Last year, at the 25th World AIDS Day celebration, President Barack Obama said, “Each year on World AIDS Day, we come together as a global community to fight a devastating pandemic. We remember the friends and loved ones we have lost, stand with the estimated 35 million people living with HIV/AIDS, and renew our commitment to preventing the spread of this virus at home and abroad. If we channel our energy and compassion into science-based results, an AIDS-free generation is within our reach.” If we, as a people, intend to see the President’s vision come true, we must continue to make better choices, safer decisions, and further medical achievements world-wide. We thank you, makers of Truvada®, for your contribution to the effort, and I encourage everyone to do your part. Here’s to an AIDS free future!



If you would like more information about HIV Prevention with Truvada® for PrEP, please visit http://www.Truvadapreprems.com/pre-exposure-prophylaxis. For specific drug information visit Truvada® at their website or speak with your licensed medical practitioner.

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