I’d been barebacking for a while but I’ll admit I was worried about getting HIV.
I was constantly searching online for ways to reduce my risk. I was having conversations with my hookups about their last tests and their viral loads.
I’m circumcised and was exclusively topping, but I knew I was still at high risk.
Then I found out online about a very effective drug that could dramatically reduce my risk: Truvada used as a pre-exposure prophylaxis (PrEP).
I studied up on it and found the science convincing, particularly as it was being recommended by the World Health Organization and the US Centers for Disease Control (CDC).
Unfortunately, it meant getting a prescription from my doctor.
I really liked my doctor. I work closely with medical professionals through my job, and I could tell that my doctor was a good one, focused on evidence-based medicine, not just what the patient wanted. He was also conveniently located across the street from my work.
But I’d never talked to him about my sex life in any way.
He’d mostly helped me with my sleeping disorder. I’m a fairly confident guy and lack nearly any form of shame, but this upcoming conversation was making me nervous.
I sat in the room waiting for him to come in.
(Deepak Chauhan/Daily Xtra)
When I was finally called in, we exchanged pleasantries and I said he must hate it when he sees a patient holding a stack of papers. His reply: he never reads them anyway. Again, to me this was a sign that he’s a good doctor. He asked me what I was in for and I said I wanted him to prescribe me a medication. He asked what for and I replied that it’s an HIV pre-exposure prophylaxis.
His eyes widened to the size of saucers.
He asked me why I thought I was at risk of getting HIV.
I was frank and to the point: I have sex with a lot of men.
He’d been standing this whole time but he sat down in his chair with a thud. He asked whether I always used condoms and again, I was frank: no, never. He just let out an “ah” in acknowledgement.
And what papers had I brought him? The CDC’s guidelines for physicians. He was probably expecting the usual bullshit that people find online, so he promptly grabbed the papers from my hand. He quickly browsed through them and asked me some questions.
(Deepak Chauhan/Daily Xtra)
Are you regularly tested for HIV? Yes, every six weeks I have an antigen test.
Are any of your partners HIV-positive? Yes, I’d say most of them.
How many partners have you had in the last six months? Oh, probably close to a hundred.
Have you had any other STIs recently? Yes, gonorrhea.
He said he’d look through the papers more thoroughly and told me to make an appointment with him in about a week.
I said I hoped I hadn’t shocked him too much. He told me he’d recently run into a gay guy he’d gone to medical school with and had a good idea of what we get up to, then he winked at me and we both laughed.
At my follow-up appointment, he simply stated that I was a very good candidate for PrEP and that he supported its use. He sent me for the battery of required tests, I got my prescription, and a short while later I began taking Truvada, conveniently starting on Valentine’s Day.
My straight, suburban, South African, Jewish doctor had been great. He didn’t moralize. He didn’t judge. He didn’t lecture me about my sexual behaviour. He simply asked factual questions and determined what my medical needs were based on my risk profile. He behaved exactly how a doctor should. If only we could all be so lucky to have a doctor like him.
(Deepak Chauhan/Daily Xtra)
However, other than getting my Truvada prescription from my doctor, I generally kept using the Health Initiative for Men clinics for my sexual health needs, including STI testing and treatments for any STIs I pick up — the usual triad of gonorrhea, chlamydia, and syphilis (I’ve had them all).
In retrospect, it was probably my interactions with the HIM clinic nurses that gave me the confidence to be so frank with my doctor about my sex life. However, a couple of incidents have since convinced me that getting my health needs taken care of in two different medical settings — one for sexual health and the other for non-sexual health — isn’t a good idea.
One weekend, it suddenly became painful to pee. It was like there were shards of glass in my urethra every time I took a piss. It was excruciating. So I saw a nurse at the HIM clinic.
I told the nurse about the pain and he said it was likely gonorrhea or chlamydia. I wasn’t so sure. I’ve had both before and each time I’ve gotten a mucous discharge and some light tingling when I pee, but nothing like this. He brushed it off saying symptoms can vary, and gave me a cup to pee in and the pills to take.
Three days later I was still in agony — my symptoms had always gone away two days after taking the treatment. I phoned the nurse, who said it just takes time and that the results would be in soon.
A couple of days later, I got a call from the nurse who sounded worried. My tests had come back negative and I should see my doctor right away.
My doctor managed to squeeze me in that day. He examined my penis and determined I likely had a small tear in my urethra and that the pain when I pissed was likely related to the scar tissue. It was likely caused by ramming my cock against a tight hole (not exactly the way he phrased it).
He said it would likely take two weeks to go away and gave me something to ease the pain.
Unfortunately, he also said that if the pain didn’t go away, I’d need some minor procedure that involves blowing a balloon up inside my penis and cauterizing the tissue. In the end, the pain went away and the procedure wasn’t required.
A friend then told me about a problem he’d had. He had had stomach problems for months. His doctor couldn’t figure out what it was after a series of appointments. It was only after talking to a sexual health nurse that he realized it could be giardia, a parasite you can get from giving rim jobs. And that’s indeed what it was.
These two issues made me realize something: as good as my doctor was, he likely wasn’t going to pick up on all the particular sexual health issues that gay men have.
(Deepak Chauhan/Daily Xtra)
We’re a distinct group and a small proportion of the population, rarely well understood by the medical profession. I could go to him with a problem and his mind would be unlikely to turn to possible sexual causes — making the likelihood of misdiagnoses high.
However, on the flip side, the sexual health nurses are so focused on sexual issues that they may not link a problem to non-sexual causes, also making the likelihood of misdiagnoses high.
So I sought out a new doctor, one who is very knowledgeable about gay men’s health issues.
As I was already on PrEP, one doctor specialized in HIV-positive guys agreed to take me as a patient. The bonus: he’s in the kink scene and likely wouldn’t sex-shame me.
He even gives me antibiotics when I go away on one of my wild trips, in case I show any symptoms. This comes in handy when you’re away from home and don’t know where to go if you end up with an STI. Whether it’s a gay cruise, Folsom, Southern Decadence or some Pride weekend away, I’m going to end up with my dick in a lot of random dudes.
During one appointment, I told him I’d turned versatile and was bottoming a lot. He immediately changed my lab requisition form to increase the frequency of my hepatitis C testing, since I was now at higher risk for that. He thought of it before I did. So I’d say finding this new doctor is already paying dividends.
Your relationship with your doctor is one of the most important any person can have. However, just like any relationship, it must be built on open, honest communication. Otherwise, it will become dysfunctional and your health could suffer.
Patients must be frank, open, and direct — drop the shame and guilt.
For their part, doctors must listen, withhold judgement, and meet you where you’re at — not where they’d like you to be. I’ve been fortunate to have two doctors just like that.
As gay men, we deserve no less.
Kevin Moroso’s Filling Station column runs monthly on Daily Xtra on the last Friday of the month.