Punching HIV In The Nuts: A How-To Guide

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Words || Nathaniel Keesing

I’m sure most of us have been there. You’ve just met a hottie and all you two want to do is smash. But you forgot the condom. Whoops. You then spend the next four weeks having panic attacks anytime you get the slightest sniffle until it’s been long enough to get an STI test. Odds are, you’re probably fine and Fiona Applebottom or Dick Smith didn’t give you HIV. But why add to our crippling existential anxiety when all you need is to know about is the miracle drugs PrEP and PEP? Here’s a how to guide on punching HIV in the nuts!

PrEP
What exactly is PrEP you ask? I spoke with Dr Benjamin Bavinton, who’s a Research Fellow in the HIV Epidemiology and Prevention Program at the Kirby Institute. He explains that if “someone considers themselves, or has been assessed to be at high risk of HIV acquisition”, then PrEP (Pre-Exposure Prophylaxis) is for you. It works by taking a daily dose of the drug Truvada, and when taken correctly, if HIV manages to get inside your body, it’s unable to replicate. If you adhere to the medication, take it every single day, and you have condomless anal or vaginal sex, you’re not going to get HIV. “It’s basically 100% effective” Dr Bavinton proclaims. That’s pretty mind-blowing to me; this right here is literally how we’re going to beat HIV.

But how do you get PrEP? The government has licenced and approved the wonder drug, but it’s not under the PBS (Pharmaceutical Benefits Scheme), so if you go to your local chemist it’s going to cost over 10k per year. Unless you want to eat Mi Goreng for the rest of your life, this isn’t really an option. Luckily there’s large scale trials of the drug, and the one here in NSW is called EPIC-NSW. It’s free, it’s still enrolling, and there’s no cap! The Kirby institute will be running the study until it’s available on the PBS, so you literally can’t lose.

I know you’re about to run to the nearest clinic and ask your doctor about EPIC-NSW, but there are some things you should know. PrEP isn’t going to stop STI’s, so you can still get the clap or Syphilis in your spine (it’s a thing, look it up). There is also ‘Start-up syndrome’, where in the first few days, “less than 5 per cent of people will experience some nausea, headaches, dizziness, and maybe some diarrhoea” Dr Bavinton warns. Sounds like a really intense cleanse to me. He also warns of some potential long-term side effects. Firstly, there is an incredibly small risk of damage to your kidney and/or liver functions, and so regular tests are required to make sure our organs are A-OK. Another risk is “the reduction in bone mineral density” which could lead to bone fractures. I wondered if this was the start of a plug for Caltrate. It’s so rare he tells me, that for all the people who’ve participated in studies and had a reduction in bone mineral density, not one person has had a fracture. Nevertheless, it’s important to visit the doctor regularly to make sure you’re not suffering any side-effects.

PEP
Okay, so imagine you’ve put as much effort into getting on PrEP as you do your readings (i.e., very little), and now you think you’ve been exposed to HIV. This is where PEP comes in. Our wonderful HIV gladiator Dr Bavinton explained what to do if you think you might be at risk.

PEP (Post Exposure Prophylaxis) is taken if you think you’ve “been exposed to HIV, usually through some form of sex that’s high risk”. Now this is the more important part, you HAVE to go to a hospital or a clinic within 72 hours of that exposure, or it won’t work. Please do not wait. When you arrive, “you’re given a course of antiretroviral medication (AKA anti-HIV medication) that you take for 28 days”. Seems simple enough. It works by “getting into the cells in your body that HIV targets, the drugs in there prevent that cell from being able to replicate that virus”. I like to imagine the drugs jumping out and shouting “Surprise bitch” and shooting the HIV with a shotgun. But because the virus is going throughout your blood and tissues, it’s IMPERATIVE that you take the drug regularly for the entire time it’s been prescribed for to make sure there’s enough of the drugs in all of the cells that could be targeted by HIV. AKA, there’s enough shotgun shells to blast a cap in every HIV virus particle’s ass.

I’ve actually been on PEP before. It was several years ago now, but after a long night of hooking, I realised I was probably a bit more unsafe than I should have been. Oh, and the person I slept with told me they might have HIV but hadn’t bothered to check yet. Awks. I went to the nearest hospital, told them I think I’ve been exposed to HIV, and they put me on PEP. That was the easy part, as the next four weeks were a living nightmare. I was constantly vomiting, awful diarrhoea that stunk up my work’s toilets, made even grosser as the loo was right next to the kitchen. Eww. The worst part was that for 28 days, my blood felt like it had been replaced with bleach. But I made the right choice. Dr Bavinton told me that it was likely I was on the older PEP drugs, and that the new combination “might have some side effects in the first 10 days, but typically the side effects of that newer combination will subside after the first week, and for the rest of the three weeks, the majority of side effects will subside for most people.” So really, you have no excuse not to go on PEP if you think you need it.

If you think you need either, please don’t hesitate to ask your doctor about it – these drugs are the answer to ending HIV.

  • EricGlare

    As a person living with HIV I think this is a great conversation to be having to help protect people from acquiring HIV even if the gun-toting imagery is completely off track from the biology. Antiretrovirals are inhibitors of viral replication rather than being themselves virucidal -which is why Truvada is two antiretrovirals (emtricitabine and tenofovir disoproxil fumarate) and a complete treatment for people living with HIV is 3 or more drugs at a time.

    There is another dynamic at play that greatly influences HIV prevention – treatment as prevention for people living with HIV – TasP for short. I have been on treatment for HIV for 20 years and for the last 18 years I have had undetectable viral load in my blood and I am unable to infect anyone else by sex. This is more effective HIV prevention than condoms. I am safer than someone who has taken risk but doesn’t know their status -and that is most people. If I had condomless sex with someone HIV negative then they would not be eligible for PEP as the risk exposure is too low to justify PEP. Antiretrovirals have removed a lot of anxiety about passing on HIV and I now have relationships with HIV negative guys confident that they will not acquire HIV from me.