Looking for PrEP, part five

Published 12, Sep, 2016

"...I’m not quite sure I’m ready to use disco dosing as my preferred method of prevention, says Alex Aviance on intermittent PrEP as he takes his first pill

Looking for PrEP, part five

I’m not coming to you as a Truvada virgin. I had a run in with the drug a year ago while taking it in combination with another HIV drug, Kaletra, as Post-Exposure Prophylaxis (PEP) after an encounter in which I thought I might become positive. My thirty days on the two drugs were basically a hot mess from start to finish. 

In those 30 days I constantly felt the need to throw up for most of the day, every day. It eventually got so bad that I was prescribed an anti-nausea drug that’s usually reserved for people going through chemo. Diarrhea and upset stomachs also plagued me for the majority of my treatment. At the end of it all, I lost about 12 pounds without even trying. I could stand to lose a little weight, but making myself so sick that I can’t keep food down wasn’t a diet plan I was prepared to embrace again any time soon.

Part of my agreement with my doctor to get on PrEP was that I would try to abstain for the first week to get my body accustomed, and so that enough of the drug could accumulate in my body to actually be effective. As I downed my first pill, my thoughts raced, taking me back to the hellish experience of one year prior.

If the side-effects returned there would be no way that I could realistically take my meds every day, and unfortunately, PrEP’s effectiveness starts to wane with missed doses. When I considered the lengths I had to go to in order to get PrEP in the first place, I realized I wasn’t prepared to give up yet.  

" The generally ramshackle availability of PrEP in Canada right now, as well as the exorbitant cost may make disco dosing the only viable method of accessing PrEP for some."

As it would turn out, a lot of that worrying and apprehension was over nothing. Compared to my previous experience, this time around is a walk in the park. This is almost certainly due to the fact that I’m only taking Truvada and not a combination of drugs as before. The nausea has returned, but it’s not nearly as intense and life-altering as it was before. Unfortunately, the upset stomachs have also returned and it’s bad enough that abstaining hasn’t been a problem because my desire to get fucked is at the lowest it's been in a while. Still, I can already feel the side-effects fading as my body adjusts. 

It’s impossible to predict how the medications might affect someone, but they’re usually minor and include nausea, vomiting, diarrhea, stomach pain, and dizziness. In about three months I’ll have to visit my doctor again since PrEP does have the potential in the long term to reduce bone mineral density as well as cause liver damage in a rare amount of situations. Those aren’t things I’d be able to necessarily assess on my own, so part of my PrEP plan includes getting them checked along with my HIV status.

When it comes to both accessing it and adhering to it, I’ve learned PrEP isn’t for everyone. Side effects play a big part in that. Some guys have taken to a practice affectionately known in queer circles as ‘disco dosing.’ Or as the doctors call it, (the much less fabulously named) intermittent dosing. It means only taking PrEP shortly before, and shortly after an unprotected encounter.  

Unsurprisingly, the pratice is not recommended by the CDC, since our current research shows that PrEP works best when taken regularly. I’ve previously viewed it as a pretty fucked up game of Russian roulette, but now that the shoe is on the other foot, I’m beginning to understand why some people might feel they have no other choice but to use PrEP this way. The generally ramshackle availability of PrEP in Canada right now, as well as the exorbitant cost may make disco dosing the only viable method of accessing PrEP for some. 

Given my past experiences, there is a sense of uncertainty I can’t seem to shake.  In the future there may be drugs that can be used as PrEP with fewer side effects, but for now Truvada is all I’ve got. All my eggs are in one proverbial basket. Despite this, I’m not quite sure I’m ready to use disco dosing as my preferred method of prevention. I can only sum up my feelings in the words of what may be the gayest disco song of all time, “I will survive.”