PrEP…Forever? When Do You Stop Taking PrEP

Published: January 10, 2013

I was sitting with a group of friends in San Francisco talking excitedly about PrEP last weekend. San Francisco’s demonstration projects have begun enrolling, and the word is on the street. Indeed, since SF was one of the cities where participants were recruited for the original iPReX study that determined that PrEP was so highly effective, the word on PrEP has been circulating in the gay bay for years now. I even noticed about a half a dozen online profiles where guys proudly declared that they were on PrEP, which I haven’t yet seen anywhere else in my travels.

The topic of conversation turned to a mutual friend, “Jon,” who recently decided to go off PrEP. “Yea, Jon just got into a relationship so he stopped taking it. They’re monogamous, I guess.” I know the friend in question. God bless him; he has a history of repeatedly getting into three month-long mini-relationships that don’t involve condoms from the get-go. Of course, no judgment here. I just prefer to skip the relationship and go straight for the bareback sex. But I couldn’t help but blurt out, “Is he crazy? They just started dating!”

HIV risk isn’t like a coat you can check at the relationship door. For starters, HIV antibody tests simply cannot detect recent infections – meaning that Jon’s new partner who’s breeding him on the regular could already be positive. Most new infections are estimated to be the result of sex with someone who didn’t know that they were positive. I’m sure Jon’s new boyfriend is a very nice boy, but let’s also not forget that “monogamous” relationships are often not really monogamous. People cheat. A study of gay male relationships recently found that 20% of gay couples who participated reported breaking their sexual agreement, and less than half of those that broke the agreement disclosed their transgression to their partner. Hell, I cheated on my ex. He cheated on me. Our version of monogamy was just chock-fucking-full of bareback sex with other people.

I get that there are guys out there in loving, committed, monogamous relationships. I don’t deny their existence. I simply question the logic of throwing your Truvada stash out the window 30 seconds after becoming someone’s boyfriend. It may make more sense for guys in Jon’s situation to keep taking PrEP for a while after getting together to figure out if this is a three-month jaunt or something more long-term.

This isn’t unlike Australia’s well-known “Talk. Test. Trust” model that advised new couples on how to go about discontinuing condoms with their primary partner back in the 1990s. Trust and open communication are critical in this model (as they are for a healthy relationship in general), as is continued HIV testing that extends beyond any potential “window period” when an HIV test might fail to detect a recent infection. We can adapt it here for PrEP. “Talk. Test. Truvada. Test. Trust.” It’s not as catchy, but the idea is the same.

Jon’s situation got me thinking. After my last disastrous attempt (and failure) with monogamy, I made a pledge to never get into another monogamous relationship. I’m just not built for it. I love sex, and I love sex with lots of people. Maybe my ideas will change someday, but from where I’m sitting I just can’t imagine being monogamous with anyone ever again.

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