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It’s saddening that gay men will unnecessarily endure suffering because of delays in making PrEP available

Philip C Baldwin

It was the 18 January 2011. The date fell on a Tuesday. I had made a note of it in my diary. On 18 January 2010, I had been diagnosed as HIV positive. That day changed my life.

This wasn’t an anniversary I wanted to celebrate. I was unsure how I felt about my HIV status. It had been a massive shock when the result came back positive. One year on, I was still coming to terms with the news. I had to be up early that morning, as I had a full day at the office. No one at work knew about my HIV, including my out gay supervisor, who was also a friend.

The following evening I was catching up for dinner with my school friend Fiona. Fiona was the first person who I had come out to as gay, in 2001, when I was 16. I had told Fiona that I was HIV positive a few weeks after my diagnosis. Almost a decade on, I felt as conflicted about my HIV, as I had been about my sexuality then. My life was full of anxiety.

On Friday morning, I had an appointment to confirm the visa application for my six-month secondment to my employer’s NYC office. The secondment started the following month. I hadn’t told the HR department at work, who were arranging the visa, that I was HIV positive. The USA had changed their immigration policy in 2010, meaning that HIV positive people no longer had to declare their status.

My employer also offered secondments to Singapore, where foreigners who are HIV positive are not allowed to reside for more than 30 days. I was lucky in terms of my secondment destination, but the process had once again reinforced the stigma around my HIV status.

On the Monday, it was my mum’s birthday. The previous year, I was so distraught after finding out that I was HIV positive, that I had forgotten her birthday. This year I made sure to send a card and flowers. One year on, I still hadn’t told my mum about my HIV diagnosis though.

Provided

The week following the anniversary of my HIV diagnosis illustrates the emotional turmoil that I experienced in the years following. There are 17 new HIV diagnoses made every day in the UK. On 10 April the Scottish government approved the provision of Pre-Exposure Prophylaxis (PrEP) on the NHS. PrEP is a pill which can be taken by HIV negative people to prevent the transmission of HIV.

The rest of the UK is lagging behind when it comes to PrEP. It is saddening that other gay men will, unnecessarily, have to endure suffering and uncertainty, similar to mine, because of the delays in making PrEP available through the NHS in England.

Despite this, the use of PrEP has become widespread amongst gay men. It is hard to gauge exactly how many gay men are currently accessing PrEP in the UK. Around 7% of gay men in London may be using it already. A lot of gay men are purchasing PrEP online. Again it is difficult to gather statistics in this area, but it is postulated that approximately a half of UK PrEP sales are made to individuals in London.

Statistics released at the end of last year, by 56 Dean Street, located in Soho, showed a 40% drop in new HIV diagnoses in 2016. London clinics and others throughout the UK have also reported falls. The UK’s complete HIV statistics for 2016, broken down and analysed, will not be released until this year’s World AIDS Day (1 December 2017). It is clear that falling HIV diagnoses are, to a large degree, the result of gay men taking PrEP.

PrEP, in conjunction with HIV positive people accessing HIV treatment earlier, against a backdrop of increased testing, has allowed us to turn a corner in HIV transmissions. It is gay men who have led the way on PrEP. Public Health England’s PrEP trial, which aims to encompass at least 10,000 people, will hopefully be commencing in the summer. Its exact parameters are still being determined, but the trial will only cover a portion of the PrEP required for the LGBT+ community.

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One year on, I still hadn’t told many of the people around me about my HIV. I found it difficult to disclose my status in some circumstances. The stigma perpetuated a sense of shame.

There is an intersection around HIV stigma and PrEP stigma. Some PrEP users have reported slut shaming. There was a comparable dialogue, in the past, around people living with HIV. People were blamed and shamed. I was worried that people would judge me for being HIV positive.

The tone of arguments made against the introduction of the contraceptive pill in the 1970’s, referring to promiscuity and lifestyle, is not dissimilar to that being made by today’s critics of PrEP. The PROUD Study and others like it have shown no evidence of risk compensation (reduced condom use) or increased STI rates as a consequence of using PrEP. Taking PrEP is responsible and is causing HIV transmissions to fall dramatically.

A year after my HIV diagnosis, I was still struggling to come to terms with it. A lot has changed in terms of HIV prevention over the last decade. Dealing with my HIV diagnosis was a difficult journey and one which I would like as few other gay men, or people from any community, as possible, to experience. It is exciting that so many gay men are taking control of their sexual health by using PrEP.

The delays in making PrEP available and the continued stigma around HIV, which cannot be unrelated, are saddening. Had PrEP been available in my early twenties, I would definitely have taken it.

Follow Phillip on Twitter @philipcbaldwin

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