James: Testing for HIV and Weighing Up PrEP
James is 23, identifies as Takatāpui, and has recently moved to Auckland from Hamilton for his fifth year of medical school. In this interview, the first part in a series with community members, he talks about his experiences testing for HIV and his thoughts about going on PrEP.
How often do you test for HIV?
At the moment I try to test every three months, but if I feel concerned about something I get tested.
Can you tell us about the first time you tested for HIV?
I was quite nervous getting tested for the first time. The doctor really helped to put me at ease. He explained all of the tests and that no news is good news. So if you don’t hear from the clinic all of your tests are negative. I also appreciated the doctor using terminology like top, bottom and vers. This seemed natural, not like he was just ticking boxes.
What advice would you give to someone getting tested for the first time?
Getting tested for the first time is a really tough situation. I go for check ups-now and I still feel anxious. Everyone feels scared and worries about their results. I know it’s better to know. Uncertainty is the worst.
Sometimes you might be worried about where to go to get checked. I’ve found that sexual health clinics work best for me. It feels really awkward talking to my regular GP about sexual activity and risk. Sometimes your GP might not have special training in sexual health, especially for sexual minorities like gay men. A few times I’ve taken a support person with me to appointments. This has really helped me to feel comfortable and supported.
Have you thought about PrEP (Pre-Exposure Prophylaxis)?
Yes I’ve considered going on PrEP for the last few months. As I’ve just moved back to Auckland from Hamilton I’m considering getting involved in the PrEP study. This study is trialing PrEP for guys in Auckland.
When I was in Hamilton I was considering accessing PrEP through Green Cross Pharmacy online. You can get a prescription for three months at a time. The PrEP is imported from overseas so you have to pay for shipping costs. At the moment the cheapest option is around $120 NZD for three months. That’s $40 a month, which is a lot when you're on a student budget.
Do you have any concerns about PrEP?
Yes - PrEP does not protect against STIs like syphilis, gonorrhoea or chlamydia, among others. Testing regularly is an important part of treating these infections early, if you get them. Some of them, like syphilis, can have serious effects if left untreated.
If people don’t take PrEP as directed, HIV can evolve to be resistant to Truvada. Even as we create new ways to deal with the Human Immunodeficiency Virus (HIV) it adapts and changes. Some of the other drug options available tend to have more side-effects which won’t be as good for long-term health.
Knox, Anderson, Harrigan and Tan (2017) reported a case of a guy getting HIV while on PrEP. This guy was taking PrEP as prescribed when he got HIV. He was taking his meds every day. So PrEP isn’t 100% effective, it won’t work for everyone. But it is just one case out of the thousands of guys taking it around the world.
There is also a lack of research on what the drug does to your body in the long run, as PrEP is still an emerging area of prevention medicine.
Have you got any reflections on testing and coming out?
It can be daunting getting tested, especially if you are not out to many people. It’s really challenging coming out in any setting, including at the clinic. You may have to tell a nurse and a doctor about your sexual identity, an identity you may not yet accept yourself. It’s weird talking about your sex life with a complete stranger. I’ve had good and bad experiences with testing but you have to work through them because testing regularly is an important way to keep you and others safe.
You can be vulnerable when you come out. When you meet people online you can be thrown into situations that are difficult to manage. My advice when you're meeting someone off Grindr, or whatever the app of the moment is, is to make sure you are in a clear frame of mind. Make sure you talk to the guy and get an idea of who they are. Know your HIV status and ask them about theirs. It can also be a good idea to tell a friend where you're going.
If something does happen that you think might put you at risk of HIV or another STI, it can be really tough. I think lots of guys struggle with feelings of guilt or anxiety or get down on themselves when slip-ups happen. But I think most of us make decisions that we might later not feel so great about when we are first coming out. Or even once we’re more experienced and confident in who we are. But the main thing is to accept yourself, and just do what you can to stay safe. Testing is a really important way that you can do that.