Positive Advocate: Gay HIV Prevention Christmas Wish List 2013

Cipri Martinez GreenChristmas is almost upon us, it’s a time when hope and imagination is given permission to occupy a superior space of a wondering and playful mind, what would be on your Gay HIV Prevention Xmas Wish list?

Easy, free and early access to HIV testing

The WA AIDS Council through the MClinic has been able to increase STI testing for the gay community. How much more awesome would it be if we could easily pick up a HIV oral swab test from our local pharmacy. Home testing is already being practised by gay men in the USA. Some people in Australia have explored and succeeded in buying the HIV test online. An informed consumer is important for this HIV prevention, as we wouldn’t want anyone to panic and take radical action on a positive HIV test result thinking they only had a few years to live. At the 2013 International AIDS Society Conference (June, Kuala Lumpur, Malaysia),  a study from the USA and Canada confirmed that life expectancy for a 20 year old diagnosed with HIV is now in the 70’s and almost normal. The more people that test and treat their HIV early, the lower are our overall community viral load.

Easy, free and early access to HIV medication

The Visconti trial demonstrated in simple terms that if you treated HIV within 6 months of infection for three years then 15% of participants would be “functionally cured” meaning they could come off their HIV medication and maintain an undetectable viral load naturally. There is some speculation that 15% is an underestimation, the sooner people start treatment the greater the likelihood that long term “HIV remission” is possible. Think about the prospects, instead of being on HIV treatment for 30+ years, people with new HIV infection may only need to be on HIV treatments for three years. There would be a huge benefit to the individual, less pill burden and its effects over a life time, being virtually noninfectious as you naturally maintain an undetectable viral load and the psychological boost of knowing you have overcome HIV the “health challenge”. Government too has reason to celebrate, the life time cost of HIV medication would be dramatically reduced. The incentives are massive, virtually noninfectious individuals that cost State finances very little in comparison with current costs. Testing and treating early is a win/win for everyone especially individuals who struggle with consistent condom practices.

Easy, free and early access to the Before Pill and After Pill to prevent HIV

Known medically as Pre Exposure Prophylaxis (PrEP) and Post Exposure Prophylaxis (PEP) respectively. The concepts here is about having enough HIV medication in your blood that should you become exposed to HIV, its replication is sufficiently inhibited that it does not establish itself within your body (If you’re interested in the science look up “iPrEx Trial” for PrEP). As for PEP some original studies were based on monkeys injected with very high doses of HIV, it found that the sooner PEP was administered the higher the likely hood of preventing HIV, every hour counts (medical protocols for administering PEP within 72 hours are well established, more information if required is on the Australasian Society of HIV Medicine website). The Before and After Pill makes the gay wish list because of the potential strategies that gay men could employ.

Consider a gay man travelling abroad, to “London Pride”, a high HIV prevalence country, or over east to Sydney’s “Mardi Gras”. He knows he’s out to party hard and likely to break his own safety rules (historical experience), he could be given HIV medication and take the pills for the duration of his holiday (known medically as intermittent PrEP). Another option is you start a new relationship where maintaining condom use is complicated, your feelings are strong, neither of you have been tested in a while and so you’re not certain of each other’s HIV status, so you start a PrEP home kit until you’ve both had a chance to test. Or perhaps you got drunk/or not and regret fucking without a condom, you go into your bathroom and start a month’s worth of HIV medication (PEP Home Kit), without wasting precious hours before treatment or time at hospital emergency. Consider a Pos-Neg couple, the partner with HIV is not on treatments, then the negative partner could consider the option for additional protection with PrEP. It could well be time for the MClinic to lead the country by having HIV medication starter kits available for gay men.

A solid cultural foundation of care in the Gay community

Our community has far too much experience with discrimination, homophobia, childhood sexual abuse, intimate partner violence, and other forms of social/human abuse and neglect. This leads some to attempt strategies that are self soothing and perhaps mal adaptive, like excessive substance use and sex. A community that is highly educated and fully accepting of one another will help reduce the most negative impacts of living a human life. If we don’t look after and respect our own, how can we expect others in society to do so.

What is the bottom line and top message? That Gay HIV prevention is about “combination prevention”. Tailoring a gay man’s individual HIV prevention strategy to his personal circumstances, context and sexual pleasure preferences ought to be on every gay
man’s Christmas wish list, have an awesome festive season.

Cipriano Martinez


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