When Jody Jollimore began using pre-exposure prophylaxis (PrEP) he quickly became acquainted with the stigma associated with the HIV-prevention strategy.
“I remember coming out to a health care provider, a gay man who I would have thought would have been quite supportive about this,” he recalls. “He got angry and his response was, ‘Well, Jody, I haven’t given up on condoms. I’m disappointed that you have.’
“I hadn’t given up on condoms but I had found another option that provided me with some flexibility,” he says.
The experience forced him “into the closet” about using PrEP.
“I felt stigmatized by that, and internal stigma that I guess I placed on myself, and that’s the angle I want us to think about today,” Jollimore told the BC Gay Men’s Health Summit on Nov 5, 2015.
PrEP has “opened up the door to have a conversation that hopefully is an honest conversation about condomless sex,” says Jollimore, a program manager at Vancouver’s Health Initiative for Men.
“For some of us, that was forbidden or taboo for so long that it seems only fitting that when we’re having these conversations there’s going to be some heated and charged discourse,” he adds.
Manufactured by Gilead Sciences, Truvada can be used to prevent HIV if taken daily. Clinical trials show that taking the drug consistently can reduce HIV transmission by more than 86 percent.
Truvada has been approved for use in Canada to treat HIV since 2006. Earlier in 2015, Gilead filed an application with Health Canada to use Truvada to prevent HIV as well. Approval is expected to take about 12 months.
(If taken daily, Truvada can be used as a pre-exposure prophylaxis, or PrEP, to prevent HIV infection./Gilead Sciences)
Jollimore hopes to see PrEP more readily available to Canadians in about two years. Willing doctors can already prescribe the pill “off-label” to patients, but that limits who can access the drug — without insurance, using Truvada as PrEP would cost roughly $900 a month.
Marcus Sanzi, a health promotion worker at AIDS Vancouver, says some of his gay clients who are able to access the treatment are still reluctant to disregard long-held messages about condoms and safe sex.
“I have a client who is 57 years old, a self-identified gay man, and he was telling me about when he was his 20s discovering his sexuality in the middle of the first HIV epidemic,” Sanzi says. “He expressed all the panic and the fear that he felt, which changed his sexual life forever.”
“Now he has a PrEP prescription, but he’s never been to the pharmacy to get his medication filled because he’s still afraid that having condomless sex will kill him.”
Sanzi says his clients face stigma around PrEP use too. One client says his friends called him a “sex addict” and “a whore” when he said he was taking PrEP.
Maxime Blanchette, a researcher on the Ipergay study in Montreal, says the process of getting a prescription for Truvada as PrEP can seem stigmatizing because it’s only made available to men who identify themselves as people who don’t use condoms systematically and have more than one sexual partner.
“We don’t meet the criteria of the heteronormative norms but are we bad?” he asks. “I don’t think so. We have to create our own sexuality. It’s the part that is pleasant in our community because we are allowed to start over and the church doesn’t say ‘you need to do that, that and that.’ We write our own history all together.”
For audience member Darren Lauscher, the debate about PrEP recalls memories of the early controversies around the birth control pill. “When the pill came out for women they went through the same sort of stigmatizing piece,” he says. “It was, ‘oh my god, she’s scum, she’s a whore, she’s a streetwalker, oh my God!’”
“That’s a lesson from history that we don’t need to repeat,” he says.
The stigma of PrEP is beginning to fade in places where PrEP use is more common — such as San Francisco, where a recent study of PrEP users found no one contracted HIV — says Mark Hull, a researcher at the BC Centre for Excellence in HIV/AIDS.
“I think the stigma will fade away as this becomes a normative strategy that people can use to protect themselves or use as part of looking after their health,” he says.
Hull also reports an increased uptake of PrEP use in Quebec, which includes coverage for Truvada as PrEP in its provincial health plan.