As Conner states above, deciding whether or not PrEP is right for you starts with YOU. At HIM, we recognize that there are many reasons you might want to consider PrEP, and not all of these are because you might be having types of sex that could result in HIV being passed. Below we’ll talk about some of the reasons guys are choosing PrEP for themselves.
High Risk Sexual Activity
A lot of guys might first hear about PrEP at a HIM Health Centre or from their own health care provider after they’ve been diagnosed with a sexually transmitted infection (STI), or after disclosing that they’ve had condom-less anal sex with another guy of unknown HIV status. These are some of the reasons that health care providers might recommend PrEP to an individual. Some HIV researchers and health care providers and public health agencies feel that PrEP is most useful to guys who have an established history of types of sex where the HIV virus can be passed, but that if you’re a guy who doesn’t fit this profile, PrEP maybe isn’t all that useful to you (because you’re probably already using safer-sex methods). The British Columbia Centre for Excellence in HIV & AIDS (BCCFE) recommends PrEP for guys who fit one or more of the following:
- One or more HIV positive sexual partner(s), particularly if the HIV positive partner is not receiving stable ART and/or does not have a consistently undetectable viral load
- Recent (within 6 months) sexually transmitted infection (STI)
- Multiple sex partners
- History of inconsistent or no condom use for anal intercourse
- Involvement in commercial sex work
- Repeated courses of non-occupational post-exposure prophylaxis (nPEP)
Of course, for a lot of us, we might fit one or more of these categories and may not think of ourselves as ‘high risk!’
At HIM, though, we know that the reasons guys might be interested in PrEP are really diverse, and may not even have anything to do with ‘risk.’ Some guys might be very comfortable negotiating condom use each and every time they have sex, but might just want to double up on safer sex methods. Other guys take PrEP because after living through the HIV & AIDS epidemic, they have a hard time letting go of the fear of HIV infection, and PrEP allows them to have the kinds of sex a lot of people in our culture take for granted- sex free from worry about HIV. For these guys, it’s almost like PrEP is as much an anti-anxiety medication as it is a HIV prevention one! Some guys might even want to take PrEP because they just want to be part of the first generation of gay guys that have access to newer tools for HIV prevention.
The point is, we don’t think it’s all that helpful to decide who PrEP is and isn’t ‘right’ for. At HIM, we think PrEP for gay men and HIV prevention is a lot like contraception for women- some of us might prefer a different HIV prevention method (like condoms), some of us might prefer to use both PrEP and condoms, and for some of us, neither condoms or a once-daily pill are a perfect answer- for these guys, we still need even more tools and approaches for HIV prevention. Instead of focusing on perfect candidates for PrEP, we think it’s way more helpful to empower gay, bi, and other men who have sex with men to make their own decisions for themselves, with the support of a knowledgeable medical provider, and to really consider for themselves whether PrEP is right for them.