In the Spring of 2017, after an especially long appointment with my primary care doctor, wherein I explained what I really did for a living and the types of sexual activity I was engaging in, even outside of my work, I filled my first prescription for Truvada. I was already late to the party in 2017, considering how many people I knew who were already very vocal advocates for PrEP. But my doctor and I talked through some elements of the drug that might be particularly helpful to me, which I hadn’t considered in my judgemental “oh I don’t have bareback sex so that’s not right for me” decision-making process.
[“’Hakuna Truvada’ Ain’t No Passing Craze!”]
The main reason that I take Truvada is psychological. I grew up and went to school in Florida in the late 90s/early 2000s, and, as mathematically near as those decades are to where we stand today, it may as well have been the 1950s for all those idiots shared about sexual safety and the behaviors of men who have sex with men. I was taught precious little about sex in school in general; sex was for procreative purposes, but allegedly people did it for fun (although no one going over our government-approved worksheets could confirm this). When heterosexual people had sex, they did so with a condom, and presumably in the missionary position with the lights off, unless they were trying to have a baby.
Sex “education” was part of a two week curriculum married inexplicably to drug use “education.” After we had learned all there apparently was to know about white, heterosexual sex, we learned about the myriad ways the Florida Department of Education believed marijuana was definitely going to ruin all of our lives.
Most of this education was about the consequences of having sex. When we learned about STDs, we learned that while it was technically possible for men having sex with women to transmit or contract HIV, it was a disease that primarily affected gay men and intravenous drug users.
That was how gay men were lumped: “gay men and intravenous drug users,” as though “intravenous drug users” was just accidentally left off of the LGBTQI+ titling. LG(IVDU)BTQI+
That was the beginning and the end of any information about gay sex, sexual safety, and HIV (aside from a very detailed worksheet about how HIV affects the body and can develop into AIDS), and the conclusions for a young gay kid were relatively simple: if you have gay sex, you’re going to get HIV.
There was no further information about preventing it or safer practices one might adopt. It was just left to our imaginations to connect the dots: dicks in butts = death. I remember a teacher sharing what she believed to be a preposterously funny joke on the matter – that G-A-Y stood for “got AIDS yet,” – and then sort of looking at us all expectantly for the laugh.
With this as my grounding, I went into my 20s with a kind of cognitive dissonance around my sexuality that would astound even Festinger. I hadn’t stop playing with dicks for even a single second since I was 14, but I knew in my heart (despite the facts I discovered on my own after high school, which lived in my brain) that I was going to contract HIV because of it and that was just the way of the world. All that separated me from AIDS was a clock whose countdown had begun half a decade before.
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Truvada has allowed me to dabble in a kind of sexual freedom – without the need for drugs or alcohol to dampen my thinking – that I was told from an early age was simply not for people like me. A freedom to connect with others in a physical and emotional way that is not enveloped entirely in the presupposition that this might be the time it happens. I was able to let myself go and be present and joyful in these engagements in a way that I had never known before. I was able to feel safety and certainty that I had been expressly informed was not available to gay men. I felt protected suddenly from something I had known for years would be my inevitable end.
The Washington Post reported this week that Gilead, the manufacturer of Truvada, earned 3 billion (with a B) US dollars on that drug alone in the last year. Gilead’s insistence on the exorbitant costs for Truvada makes something that could help so many, nearly a luxury item. If one does not have insurance that covers PrEP, the out of pocket cost is anywhere from 1600-2000USD per month.
[Woody Fox Talks Condoms, PrEP, and Bareback]
Most often when pharmaceutical companies are publicly called to task for the costs of medications (particularly ones that treat or prevent life threatening diseases), the justification for the dollar amount involved is related to recouping their initial spend on research and development. There is no other reasonable way for them to explain the retail price of pills containing a few cents’ worth of chemicals and minerals, mass-manufactured by the million. So R&D is suddenly proffered as an enormous expense to companies like Gilead which they must try to “recover” by charging 67$ per pill, once it has been approved and patented.
Gilead didn’t fund the R&D for pre-exposure prophylaxis use of [Truvada]. The federal government… did. In other words: taxpayers did.
The thing is, in the case of Truvada, Gilead didn’t fund the R&D for pre-exposure prophylaxis use of that drug. The federal government, though the Department of Health and Human Services, did. In other words: taxpayers (and the Bill and Melinda Gates Foundation) did. And the DHS holds the patents for its use.
Truvada (the drug used for PrEP) is an incredibly cheap drug to produce – FDA approved generic versions are available *today* in other countries for less than $6 a month. @GileadSciences currently charges over $2,000 per month. (2/9) https://t.co/OywWAgmU4G
— James Krellenstein (@jbkrell) March 27, 2019
If we want to make that one step worse, since Truvada is covered by subsidized health insurance plans and Medicaid, taxpayers also feel the enormous cost (on which Gilead insists) passed on to them today.
The #BreakThePatent campaign seeks to encourage the Federal government to break Gilead’s patent on the use of Truvada as PrEP, and has mounted an information campaign designed to show the ways that this company is essentially stealing from taxpayers, and denying a lifesaving drug to those to whom it would be most valuable. I encourage you to read their site and sign the petition they have established. Then to share it with as many people as possible.
HIV is preventable, and PrEP should be available to anyone.
Tyler Dårlig Ulv is an Ontario-based blogger and professional companion. He has worked for Rentboy.com, Manhunt, and contributed to publications like Queerty and Thought Catalog. You can follow him on Twitter and Instagram, or find out more about his work at his website and blog. Tyler lives full time in Toronto.