PrEP (Pre-Exposure Prophylaxis with Truvada being the most common tablet of choice) is emerging as the medical answer to ending HIV transmission between men who have sex with men. A single tablet a day maintains immunity.
However, a major long-term side effect can be with kidney and liver functions as well as with bone density. Older men are particularly prone to issues with the latter – and I'm one of them.
I've always been a sexually active man and that continues today. After 35 years of strict condom use I saw PrEP as allowing me the freedom to once again enjoy bareback, unprotected sex with men. Of course, this meant I would be exposing myself to any potential STIs (Sexually Transmitted Infections) that my chosen partner might be carrying, but that was a manageable risk I was willing to take. My thinking was that the occasional STI would be a short-term and easily treatable annoyance, whereas HIV would be for life.
After the obligatory blood tests checking for sexual infections proved that I was STI free, my doctor was happy to prescribe PrEP. Almost as a passing thought he decided to also send me for a bone density scan. He informed me that the latest research indicates that I could have between 2 and 4% of my bone density leached within a year or so if I took PrEP each day.
The result: As I tested in the osteoporosis spectrum I was immediately taken off the daily PrEP.
My disappointment was immediate and profound.
But then came the compromise – On-Demand PrEP (or PrEP On Demand as some call it).
I was told that when I knew in advance that bareback unprotected anal sex was likely, that I could take 2 PrEP tablets between 24 and 2 hours before the event, and when my sexual binge had finished, to take a single tablet each day for the next two days. That would still protect me from contracting HIV.
That to me was like a gift from the gay gods. That meant that I could indulge in say, a group sex event where multiple acts of anal intercourse would happen, and still go home without any worry in my mind. Sure, there could be an STI showing up later, but at least for the immediate few days I had that peace of mind – in itself, a wonderfully liberating gift.
For promiscuous men, the frequency of group sex at sauna/bathhouses, special group sex events and sex with anonymous individual men might mean that those four tablets could quickly almost reach the level of what a single one-a-day regime would equal, hence no particular advantage for On-Demand PrEP – and still not helping with the bone density issues.
As for me, condoms will need to continue to be my primary source of prevention. Now that I'm over the disappointment and having seen the sexual freedom dream disappear, then this compromise doesn't upset me as it simply means a continuation of what I've already practised for three and a half decades of safe sex. However, On-Demand PrEP does now give me occasions to safely play as naked and as bare as I desire and still go home with that all-important peace of mind. It's the best of both worlds.
And of course, I'm now actively seeking ways to add calcium to my diet so that I can at least maintain my current bone density levels, if not improve them.
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