To Educate The Educator

PrEP protects against HIV but yes, it doesn’t protect you from everything else. Nothing does completely. I’d been traveling for the last few months and in Berlin I felt a discomfort at the tip of my penis along a mild burning sensation when I peed. Funny thing was, I’d only had oral sex in the last few months, mainly in public settings. This wasn't conscious. I only realized this when I was trying to figure out how I got the presumable STI. Out of all that sex, I’d only given one guy a blowjob. The other times I'd been on the receiving end of things.

I didn’t have regular insurance to see a doctor but there was a free sexual health clinic not far from the gay district. At the clinic I indicated on my form that I was on PrEP. They were yet to approve Truvada in Germany and you couldn’t even order generics legally, so I knew it'd be unusual for them to see.

One of the national gay magazines was writing about PrEP but I was yet to meet anybody who actually used it. It’s not like in North America, especially in the US where scores of people on Grindr or Scruff indicate that they’re using it. By and large it was still a big unknown in Germany. Plans for implementing PrEP as a fully funded component of national HIV prevention are still in their early stages in much of Europe.

I found this somewhat unsettling given how big Berlin's sex and drug cultures are. Berlin is home to some of the most infamous sex clubs in the world, and most gay bars or clubs have backrooms that are opened until dawn—bareback sex is quite prevalent from what I’ve witnessed. Since the city is a mecca for sex culture, tourists flock from all over the world to experience it. That only makes things more concerning.

After about twenty minutes, it’s my turn to see the nurse at the sexual health clinic. He asked me standard questions about my symptoms: how long have I felt the burning, etc. He concludes that it's either chlamydia or gonorrhoea but I'd have to get tested by the doctor upstairs when we're done to know for sure. He then went over my form and asked me how long I’d been taking PrEP. Over a year, I told him. “You should still be using condoms,” he said. “There are other STIs you can get, like this.”

I explained that for the most part I still do use condoms and that in fact all I’d done in the last little while was have oral sex. I had no reason to lie. According to the CDC, syphilis, chlamydia and gonorrhea can all be contracted via unprotected oral sex as well as anal and I'll be damned if I start using condoms for oral.

“I take it that a lot of people don’t use PrEP here since it’s not approved?” I said.

“No, not a lot. Many health professionals are weary because we want people to keep using condoms,” he said. “It will promote people not to.”

“I’ve been going out quite a bit here and I can tell you that people aren’t using condoms anyway. Seen it for myself. I don’t know what the stats are here but in the US there are 50,000 new cases of HIV per year. We know that many people don’t use condoms anyway so why not get the drug to them at least?”

This made him think. “Yes, that makes sense.” He paused for a moment. “I just don’t like the idea of being prescribed a drug that needs to be taken daily when it might not be necessary.”

“For many it is necessary. That’s what I’m saying. Plus, if somebody becomes HIV positive they’re going to have to take more than just Truvada. And then there’s the stigma, which is probably the most damaging than adding a drug to the system. Also, you don’t take it for the rest of your life. Right now, I’m single, I’m traveling, and I’m having a lot of sex even though at the moment it’s mostly oral. It makes sense for me.”

“What about the side effects?”

“You get monitored every three months to check the kidney’s make sure that everything else is fine.”

The nurse thanked me for the information, gave me a slip with a number and told me to go upstairs.

When the doctor was finally ready for me, she looked at my form and asked me about the PrEP as well—how long I’d been taking it for. Over a year. She informed me, as well, that it doesn’t protect against other STIs, which I told her that yeah, I know and yes, I do still wear condoms for the most part. “I'm certain I got this STI through oral.”

She asked me to lower my pants and push on either side of my penis head to spread my urethra. She inserted this long instrument with a loop at the tip into my penis and took a sample. It turned out that I didn’t have gonorrhea so she assumed it was chlamydia. She took a urine sample to test, wrote me a prescription and told me to return the following week to get my results.

There’s always a risk for STIs when you have sex—it’s just a part of it all, whether you’re on PrEP or not. What is certain is that PrEP protects against HIV, which people seem to ignore. At the end of the day condoms don’t always work and people don’t always use them. These are the facts and we should work with what we know.


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