The PrEP Diaries: A Safe(r) Sex Memoir by Evan J. Peterson; Lethe Press, $18.
"I love PrEP. I love it, love it, love it. It allows me to go into each new dating or sexual situation with absolutely no fears about HIV. I grew up terrified of AIDS. I grew up afraid that I'd get it from love, from rape, from a hasty blowjob between strangers. I grew into manhood terrified of AIDS. Now that I'm in my 30s and PrEP is real and poz-undetectable status is real, I'm giddy to have all the friendly, informed, affectionate sex I missed out on as a younger man." Evan Peterson's new memoir reads like a born-again Christian's testimony, only it isn't the divine presence that has changed his life but Truvada. Known as PrEP (Pre-Exposure Prophylaxis), since 2012 this drug in the form of a daily pill has been prescribed to prevent HIV infection in HIV-negative people, developed by the Bay Area pharmaceutical company Gilead.
Peterson's stories, mostly his but from a few others interviewed, show how taking PrEP has been a source of sexual liberation. He was meeting sexy, intelligent poz guys, and the drug enabled him safely to date them. With all the zealousness of a new convert, Peterson aims to spread the gospel of Truvada, believing that we have an effective medicine to prevent HIV transmission. Out of 1,000s of people using the drug, there have been only two reported cases of people contracting HIV, rendering it 99.99% effective, a better statistic than birth control pills. The chief objection about PrEP has been its branding as the Slut Pill (or its users as Truvada Whores), that it invites promiscuity. Peterson observes this sex-shaming has been directed at gays by other gays. "I've seen countless gay men direct vicious verbal attacks at one another for wanting to enjoy condomless sex without a risk of HIV." He points out that PrEP is also "for the health, peace of mind, and pleasure of HIV+ people (often marginalized in this discussion), dissolving much of the stigma and undoing three decades of fear, shame, and rejection."
Peterson is rightfully concerned that young queer men, because they haven't experienced their friends dying of the disease, ignore AIDS and the possibility of seroconverting. For him, talking about PrEP "can be a great way to build a connection with someone. It's personal enough to create some trust and disclosure, it's a hot current topic that's relevant to most gay guys, and since it leads directly into questions about safer sex practices, talking about it can be a form of verbal foreplay."
Peterson answers objections people might have about taking PrEP, but there are two caveats he doesn't address. First are the long-term effects of taking a drug for an illness one doesn't have, potentially a lifetime of chemotherapy. We now know that HIV+ people taking the protease cocktail are aging faster and contract chronic conditions such as heart disease and cancer at least a decade earlier. Truvada hasn't been around long enough to know how it will impact those who take it. Most doctors think the risk is low, but it still is an unknown variable, and Peterson should have alluded to that possibility. He does mention that people can go off the drug for long periods (i.e., if they are in a monogamous relationship with a negative partner), then resume usage later. Secondly, we learn everything about Peterson's sex life, especially his fear of bottoming, so whenever he engages in anal sex, even as a top, he uses condoms. So there is very little discussion about condomless sex, certainly a concern of many PrEP users.
Peterson is candid and witty, though there is a great deal of redundancy in the details. Still, this friendly-user manual about PrEP is much needed. Peterson is particularly effective in exposing the culture of judgment in the gay community about each other's sexual decisions (and the critique of rampant promiscuity), a shaming that can prevent guys from talking with their doctors about starting on PrEP or even taking an HIV test for fear of facing the results. Peterson also makes an excellent point that while PrEP does not stop STDs, and STDs might be on the rise among PrEP users, people on PrEP are being tested for STDs more often. He also rightfully indicts physicians, nurses, and pharmacists for not being more familiar with PrEP. While hardly the final word on the pros and cons of PrEP, we can commend Peterson for his honesty and vulnerability in advancing the discussion.