Name of interviewee: Oscar
When did you start taking PrEP? 2 years ago
Why did you decide to start PrEP?
I had unprotected sex so I got prescribed Post-Exposure Prophylaxis (PEP). When I was taking PEP I did not have any side effects, and I thought why not start PrEP now? I was single at the time.
How have your sexual relationships have changed since you are on PrEP?
I have a feeling that I have a protection I did not have before, so I started to feel more open, more relaxed. I started to let myself go more easily with the contact of people. It was a very hard time for me. It was a very hard separation with my partner. When we separated I started having a lot of sex with different people, and that helped to mentally separate from him. And PrEP, on the other hand, helped me to feel more protected in regards to HIV.
Do you have friends who are on PrEP? If so, have you talked with them about how their sexual relationships have changed because of PrEP?
One is my ex-partner, because we see each other once a month. He is on PrEP. When he was an adolescent, he suffered sexual assault from his uncle. All his life he struggled to accept his sexuality and to live openly. His family is also very religious. He told me that PrEP has helped him to feel open and to have sex with other people. It helped him to accept himself. Another one is my current boyfriend, he is also on PrEP. I think young people now – both of them are young – can’t imagine their lives without PrEP now. Most of the people with whom I had sex once, all of them are on PrEP now – or they pretend to be on PrEP -, but I don’t think there is no sense to lie. I think most gay men in NYC and in Canada are on PrEP.
How do you experiment sexual pleasure now that you are on PrEP?
I don’t know if it is connected directly to PrEP or not… I had had a lot of sex in my life, but I had never had such good sex like the one I have now if you take the last two years of my life, the time that I have been on PrEP. I never could get what I have now actually. Is it PrEP or a complex of factors? Even my ex-partner, when we met for the first time after breaking up (and after I started taking PrEP two years ago), told me: “Oscar, you are such a different person in sex, what happened to you? You have turned into this god of sex It is connected to PrEP or not?”
Additionally, if you had asked me two years ago to participate in this kind of interview about sexuality, sexual pleasure, and PrEP I would never have done it. It would have been absolutely inappropriate to me. I could not even discuss those issues with my friends, and now there is no problem anymore for me to talk about this.
How do you think other people experience sexual pleasure while on PrEP?
I think it makes it easier. For what I remember of the era before PrEP, people were avoiding some kinds of forms of sex, which actually did not represent any risk or little risk. For example, people who were afraid to kiss each other because of HIV. Of course, when you are having sex is not the time for the lecture, so I did not want to spend my time explaining that there was no risk, but I see now that people even without having that much knowledge about HIV, PrEP makes them more open to different sexual practices that are actually safe without PrEP, but people start to do it because now they feel some kind of protection.
Thinking about the before and after PrEP, is there another thing that has changed, in the way you hookup or select your partners?
Before I started taking PrEP I thought that I was not handsome enough compared to others. Now actually I am more confident in myself and I am more picky because I can hookup with guys that I could have never slept with two years ago. I used to believe they would never be into me, but that has changed. If I like someone today, I am able to do it. It’s about some kind of mental liberation. Three or four years ago, when I was not sure in myself to hookup or start the conversation with a guy, I always used some kind of excuse for me not to start the conversation with the person. That was my internal barrier, which I don’t have anymore. I was not sure in myself and I used HIV or something else as an excuse not to talk. I don’t use excuses to myself anymore.
How do you think this process of hooking up has changes for other guys who are on PrEP?
One thing that concerns me a bit, is a common question that a lot of people ask: I am negative, on PrEP, are you drugs disease free (DDF)? People think that if they ask this question and if they get as reply that the other person is “clean” or DDF, they trust him completely.
Thinking about the use of drugs and sex, how do you see PrEP in the context of guys who are on PrEP?
I can’t say nothing. I am not into PNP. Is it good or stigmatization from my side? I don’t know, but I just avoid people who are into PNP.
How do you think PrEP can influence intimacy between two men?
What I see now with my ex partner, even if we don’t plan to be together anymore despite seeing each other sometimes and having sex, it helps. Because at the time when we were together, that was one of my problems. I knew he could bring something in our relationship, and now it really helps to have an open discussion of many things. It is also some kind of stuff to do together in the morning: Albert did you take your PrEP? Oh no, I forgot, and the next time is Oscar don’t forget to take your pill.
How do you take the decision whether to use a condom or not, now that you are on PrEP?
Actually, with my ex partner we don’t use condoms. Every time I have sex with someone else I prefer to do it with a condom, but it doesn’t happen every time… Unfortunately, it is when I am totally drunk when this happens with other guys. I think alcohol is one of the reasons/motivations where I would choose not to use a condom, and I think Why not? If the guy wants to do bareback, and you are drunk, I am like: Oscar you take this stupid Truvada every day, just go ahead and try this.
How do you think other guys go around this? About when to use a condom and when not?
Guys on Grindr tend to think: I am on PrEP, you are on PrEP, then let’s do it bareback… 95% of the times. I think now this is some kind of problem. On Grindr, it is difficult to find someone who likes to have protected sex. You have to spend a lot of time looking…
Do you feel there is a stigma around PrEP?
Yeah, from colleagues. During a professional discussion, a colleague said: Maybe it is better for gay people not to be promiscuous and public health will save money on PrEP. And I said: I am sorry, it is not about promiscuity. I am on PrEP! The person replied by saying: You? Why are you on PrEP? And in the community there is stigma also. One of my closest friends told me one day: When you met him three years ago (my ex partner), he got you to do these bad things like taking PrEP.
Have you been able to talk openly with your provider? And what has been your provider’s approach to talking openly about sexuality?
When I am asking him something, I can feel he feels so uncomfortable to talk about sexuality despite he is a PrEP doctor working in a gay friendly clinic. Last time, when I mentioned that I had had unprotected sex. he said: Oh no problem, it was just an accident? And I said: No it was not an accident, it was my ex partner, we have unprotected sex. And he said: Ok, we will check it. Then I said: But, what type of test are you going to do? And he replied: Oh we will take your urine. I said: So sorry, but I was the receptive partner, so I need to have anal swabs as well. And he is like: Really? I am a medical doctor myself, and I know proper tests need to be conducted, but the persons who do not have a medical background won’t get the right tests in situations like this, when the physician does not know how to ask questions about sexuality. I also told him when I began taking PrEP: I have terrible nightmares, problems sleeping, and he said: There are not such side effects, and I was like: Are you sure? And after the nurse took my blood, he said: Oh you are right, there are some. Would you like to stop it? And I said: No, my question is if you have some advice on how to minimize them. However, he did not give me any advice.