Let's talk about PrEP
PrEP is referred to oral pre-exposure prophylaxis, a new HIV prevention approach where HIV-negative individuals use anti-HIV medications to reduce their risk of becoming infected if they are exposed to the virus. According to iPrEx study, PrEP provides 92% to 99% reduction in HIV risk for HIV-negative individuals who take the pills every day as directed.
To take PrEP or not to take PrEP? That is the question; the question that’s trending among gay men, me included, who are still learning about the breakthrough medication. HIV new infection is increasing among young gay men in Bangkok, according to the most recent study. Nearly half of young gay men in Bangkok not using condoms consistently acquire HIV within five years of starting sex. PrEP is not a silver bullet to eradicate the epidemic, but it is considered to be effective to fight back the worrying statistics; or at least that’s the premise of “Are You PrEPared Enough?” – the dialogue co-organized by UNAIDS, FHI360, Youth Lead and Youth Voices Count in commemorating IDAHOT with young gay men and transgender people (YGMT) in Bangkok.
The dialogue, while not solely focusing on PrEP, explored different online strategies in delivering various HIV knowledge and care to YGMT in Thailand. I myself was invited to become one of the panel speakers. As TestBKK’s campaign assistant, I took the stage to share the success stories on how TestBKK scales up HIV testing intake among Thai young gay men using online platforms. Sharing the podium with me, there were PrEP expert Dr Donn Colby from Thai Red Cross AIDS Research Center and Anh Lieu Vu, a young gay man who had been recording his new journey on taking PrEP on his YouTube channel. As the microphone moved to the hands of these two gentlemen, the Dialogue essentially introduced the audiences to PrEP’s essentials.
Let’s get technical.
I am young, single, gay, but not on PrEP. I first learnt about PrEP at the birthing stage of TestBKK campaign in 2014. Back then, many of the clinical trials on PrEP were still being conducted or, if they have produced a result, were underpublicized – just like an awesome Facebook status that doesn’t get many Likes. In February 2015 WHO recommended PrEP as an important additional prevention measure for MSM, gay men and sero-discordant couples. Since then, the topic of PrEP has been glamourized more than ever. The PrEP skeptical argues that the medication give people the excuse not to use condoms. The PrEP curious wanders about the long-term effect of the consumption. The new PrEP users want to know how long it takes for PrEP to become protective - and these are just a glimpse of the whole PrEP questions out there that I myself don’t know the answer of. That’s why I put on my audience hat real tight when Dr Colby took the spotlight. There were a lot things I needed to learn about PrEP and I believed many other young audiences in the room felt the same.
Dr Colby, looking sharp in his button-down shirt, explained the nitty gritty of PrEP to respond to the skeptical, the curious and the new users. PrEP doesn’t exist to give free pass for bareback sex. PrEP exist as a great solution to the struggle on the HIV-related behavior change (in this case, the current trend of unsafe sex practice among us humans). Behavior change is not easy, even when the stakes are high. We know that exercise and eating well is important, yet obesity is still on the rise. We also know that tobacco shortens our life span, yet million smokers continue to smoke.
Just like all other medicines that are taken in long-term, PrEP pill could have potential long-terms effects. Dr Colby elaborated that, therefore, it was prominent for us to understand that taking PrEP entailed a regular check up with a doctor, at least once in three months, to monitor any possible health effects. There are minor concerns about increased kidney function, and that is why, PrEP supplier clinic like Thai Red Cross undergo regular kidney check for its PrEP takers. There are also other petty distress on decreased bone mineral density that, according to Dr Colby, can easily be tackled by regularly drinking (calcium-rich) milk.
It’s estimated that it took at least four to seven days for PrEP to reach high levels of protection in the body, Dr Colby explained to the audience. But does that mean we shall only take PrEP a week before we engage in high-risk behavior? In theory, maybe. However i practice, definitely no. Sexual activity does not work that way, as if we were booking a ticket for Lady Gaga. Most of the time, we never know when it happens. This hold even truer if we’re single and ready to mingle (or, say, always checking Grindr every 5 minutes). That is why daily consumption of PrEP is highly important to ensure the continual protection for our body.
Let’s get topless.
No one is as savvy as young person when it comes to promoting themselves on social media. This doesn’t necessarily mean a bad thing. In fact, it’s a good thing. Take the case of the next panel speaker, young Vietnamese gay man Lieu Anh Vu, who shared his PrEP chronicle on his social media channels (namely Facebook, Twitter, Instagram and YouTube). Knowing that information and access to PrEP are still very limited in our region, Vu took a great initiative to share his experience as young gay man living in Asia taking PrEP. Not just that, Vu understands his target audiences very well. He narrates his stories on video without his shirt on. Nice-looking bare chest is a viral online material among young gay men. He is not alone in this, there are many gay YouTuber ‘stars’ who often appear topless like Davey Wavey, Bryan Hawn and ScottyDynamo, for example, have almost million followers. Simply put, the bare-chested Vu wants to educate as many young gay men as possible.
Utilizing bare-chested men to promote PrEP, along with other HIV knowledge, has also been the tactic used by TestBKK’s campaign – and it works. Sex sells, including in the topic of sexual health. TestBKK’s Facebook page often posts contents showcasing men with hot chiseled chest, be it an article about that sexy math professor who’s also a fashion model OR a video of Turkish mud wrestling. We do this to retain our (3000 and counting) Thai gay followers so that they are also exposed to vital HIV information we post on the page. When we post memes about PrEP we generate active conversations with lots of followers who want to know more about the PrEP. The questions vary from asking referral such as “where can I get one?” to myth-busting seeker like “Is it true that I will get too dizzy to party if I take it?”
During Song Kran 9 GCircuit, Asia’s biggest gay rave party, in Bangkok last April, we set up informative booths to promote HIV testing, condom usage and provide in formation about PrEP among the partygoers that came from all over Asia. Again, to attract them, we had statuesque model men in their underwear as the “salesmen”. As a result, we had over 800 partygoers interacting with our booths. Among them were gay men who just firstly learnt about PrEP.
Let’s get PrEP now?
It’s our genitals, it’s our adventure, and it’s our sexual health choice. We all should make our own well-informed decision to decide whether or not PrEP is the right regimen for us. Don’t let sex-shaming and misinformation spree impede our decision making process. Much luck to YGMT in Thailand, we have friendly doctors and clinics we can visit to get a thorough consultation. Better yet, Thai Red Cross’ Adam’s Love Facebook page allows their followers to consult any questions relating to PrEP (in Thai or English) through Facebook chat, making it easy for curious YGMT who’s still too nervous to meet a doctor. I truly hope this PrEP-friendly trend will soon hit other countries in the region – hopefully before a new boyband fever hits YGMT’s music scene – and I am optimistic with this aspiration. I know how committed APCOM and partners in the region in pushing through the barriers for improving sexual health of gay men across the region.
Within the next few months, APCOM will be hosting a two and a half day regional dialogue and consultation involving members from the MSM community (including young people), National AIDS Programme Managers, key representatives from health ministries, UNAIDS, UNDP, and WHO and other development partners. Through this dialogue APCOM hopes to stimulate discussion and form key recommendations that will aid national policy makers, programmers, development partners, and community members to consider the potential application of PrEP, as an additional prevention tool, in reducing HIV incidence among high risk MSM populations.