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“Pleasure on PrEP: The Interviews” by Antón Castellanos Usigli with illustrations from Daniel Arzola

by Antón Castellanos Usigli, March 7, 2017

As a public health professional who works within an HIV prevention program in Brooklyn, New York, I have had the opportunity to be involved in the beginnings of the most recent biomedical innovation for HIV prevention: Pre-Exposure Prophylaxis (PrEP). PrEP is a pill (called Truvada) that you take once a day to prevent HIV; it has a high effectivity (around 92%) if you are completely compliant and don’t miss or skip doses. When you are on PrEP you need to visit the doctor every three months and get tested for HIV and other Transmitted Infections (STIs). As of 2017, PrEP is only available in a few countries, such as the US, the UK and Canada.

Antón Castellanos Usigli & Daniel Arzola

Antón Castellanos Usigli & Daniel Arzola

I am always honest with other gay men who tell me they are interested in PrEP: I know the majority are interested because they don’t use condoms regularly and they want the added protection against HIV that it provides. Either with or without Truvada, they will likely continue being irregular condom users, so PrEP represents a good option for them. However, I do have conversations about the ways in which they are making decisions in their sex lives and about combination prevention (condoms + PrEP). In the end, PrEP only protects against HIV (not against other STIs), and although it is highly effective, it is not a guarantee that you won’t get HIV; that is why combination prevention is important. Usually, those who are not able to negotiate and speak openly with their partners about sexual pleasure and safety have more difficulties to make good decisions for their sexual wellbeing. Some, for example, do not dare to tell their partners that they want to sexually experience with other guys and end up acting out their desires without protecting themselves. Others do not feel comfortable telling their partner that they want to use condoms after hearing that their partner enjoy barebacking (anal sex without a condom).

It is in PrEP where I have found one of the best opportunities to talk openly with men who have sex with men (MSM) about these and many other issues connected to sexual pleasure and safety. If you like to bottom or top without a condom, why is that and why do you think PrEP is a good option for you? If you are on PrEP and choose not to use a condom with one guy, how are you making that decision? If you find pleasure and comfort in having sex with a condom, how are you going to negotiate with your partner, who is also on PrEP but likes barebacking? Being able to talk about sexual pleasure is fundamental for MSM (and for everyone in general) to become aware of how they make the decisions they make, and to make better decisions.

With the intention of exploring different stories about sexual pleasure in the era of PrEP, I am launching a series of interviews entitled Pleasure on PrEP. My intention is to build greater understanding on the impact that PrEP is having in the lives of MSM around the globe, specifically on issues of sexual pleasure and intimacy. In the world of HIV prevention, having conversations about risks is the common norm. Pleasure is many times left aside, yet it is the main driver of sexual activity and is related to the sexual decisions that we all make. The Pleasure on PrEP interviews aim to throw more light into this unexplored issue. I am also thrilled to announce that these interviews will be accompanied by illustrations of the world-renowned artivist Daniel Arzola, the creator of I’m Not a Joke Campaign. Daniel is a friend since 2014, when we participated together in the Stand By Me campaign during Amsterdam’s Gay Pride. He is a champion of sexual diversity, an advocate for PrEP in Latin America and his art will convey very strong messages about sexual pleasure, sexual health & PrEP. Follow and share the Pleasure on PrEP interviews with the hashtag #PleasureOnPrEP