GMFA How has PrEP affected people living with HIV? When conducting our PrEP survey for this issue, we didn’t want to just invite HIV-negative people to the conversation. We also wanted the thoughts and views of gay men living with HIV. PrEP has made a huge impact on the gay community – something the survey proves. From reducing fear around HIV to people having more honest conversations about their status, PrEP is altering gay men’s sex and personal lives. But how has this impacted the people already living with HIV? WOULD YOU HAVE TAKEN PrEP? 20% of the 756 respondents to the survey told us that they are living with HIV. We asked them how long ago they were diagnosed. 5% said less than six months ago, 3% said less than a year ago, 5% said a year ago, 16% said two to three years ago, 17% said four to five years ago, 16% said six to nine years ago, 5% said ten years ago and 33% said over ten years ago. That means that 82% of respondents were diagnosed with HIV before PrEP became available. We asked them if they would have taken PrEP if it was available: • 75% said yes • 6% said no • 19% weren’t sure. “Living with HIV is not a choice I would readily make,” explains Raleigh, 32, on why he would’ve taken PrEP. “Popping pills every day, meeting with doctor…it’s a lot of stress. If I had access to PrEP, I would have jumped at the offer. I would have saved me a whole of adjusting that I have had to make because of HIV.” Some people living with HIV are unsure whether PrEP would’ve been right for them. Joe, 41, said: “Honestly, I was quite reckless in the risks I took in sex before my diagnosis. I was not keeping up with my sexual health, so I don’t know that I would have got it together and organised PrEP for myself.” “It doesn’t replace a condom and doesn’t protect against most STIs,” believes Stephen, 59. A sentiment echoed by Sid, 60. “Because condoms do the same job and protect against other STIs.” PREVENTION WITH PrEP 80% of those who were diagnosed before the availability of PrEP believe that it would have prevented them getting HIV. “My then partner and I practiced condomless sex and our relationship was open, explains John, 49. “We don’t know who became HIV-positive first, but PrEP may have prevented us both from becoming positive.” Joe, 41, also believes PrEP could have stopped him getting HIV. “If I could have taken PrEP when I was having riskier sex, then I like to think I’d not have got HIV. It is ironic that now it is available, now that I have HIV I’m not having the risky sex anymore. Since I am undetectable, there is no risk of me passing on HIV to anyone, whether or not they’re on PrEP. But I think it’s great that PrEP is available for guys that might need it.” “I have been with the same partner for 26yrs. We got together at 16,” says Christian, 42. “Most of our time on the gay scene was spent in the late 90s and early 00s when the dance scene was going strong and drugs were a big part. Obviously in times of drug-fuelled passion condoms didn’t even come to mind as the only thing on your mind was getting down to it with any one that was there. If I could have taken a pill once a day to make sure you stayed HIV-free then I wouldn’t have thought twice about taking it.” Christian, 42, agrees. “If there was a way of preventing HIV without a condom then I would have used it. I really don’t like condoms and most of the time if you have a drunken hook-up, no matter how good your intentions are, sex without them will happen at some point.” However, not everyone entirely agrees. Such as Phil, 52. “I can’t answer that question as it wasn’t available. I’m pretty sure it will not be effective in a 100% of cases. HIV is no longer a death sentence and we have fantastic medication already supplied by the NHS. How about the media put HIV back in the spotlight and educate the next generation as opposed to sending the message ‘go be promiscuous if you want we’ve got you covered’, because we haven’t!” FIGHTING STIGMA We asked whether the introduction of PrEP has helped reduce HIV stigma and the responses were pretty split. 44% said yes, 33% said no, and 23% weren’t sure. “It has opened up the conversation around HIV. More people are informed about the topic,” believes Alex, 31. Jason, 53, has a similar belief. “I think more people are prepared to talk openly about HIV. It also contributes to breaking down the stigma around HIV. Plus, there’s the strong message that an HIV-positive person on effective medication cannot pass it on.” Lee, 36, disagrees. “I think PrEP is seen as the wise and sage choice, whereas HIV is still seen as those that were too stupid or whoreish to use condoms.” “Stigma is still there as not everyone is aware,” says James, 34. “Predisposition from fear of judgement or from a medical professional on their choice of sex life, from peers for taking it or being branded a slut.” “People say they take prep as prevention but if you told them your status they still are reluctant to take it further,” Christian, 42, tells us, “even if you tell them you’re undetectable. The idea of putting yourself purposely in harm’s way, even with no risks, still unnerves people.” Despite the positive impact of PrEP across the board, there’s still a lot of work to be done in regards to education around HIV and the PrEP pill itself. Education and a clearer understanding about viral load and what it means to be HIV-undetectable can help ensure a gulf doesn’t appear between those living with HIV and those taking PrEP.