Writing under a burner account, a very anxious gay bro came to his fellow r/askgaybro Redditors in secret to find out what he should do next. “I’m on PrEP, and I’m hiding it from the guy I’ve been dating,” wrote u/preppythrowaway in a post dated two years ago. “How would you react if you were in my [boyfriend’s] position?”
For some, the unnamed gay bro’s concerns might seem overstated. I mean, what’s the problem? That he’s taking a pill that’ll make it almost impossible for him to get HIV? That he’s making minor medical decisions for himself without clearing them first with some guy he’s been seeing for three months? Canceled forever!
But stigma around PrEP use can become a serious problem for romantic partners, to the point of discouraging either party from taking the HIV-prevention drug. Look no further than this four-year-old post on r/Advice, where another Reddit user asked what he should do after stumbling onto his partner’s bottle of pills. “I NEVER knew he was on these,” wrote u/felhawke. “Is it wrong for me to be upset about this?” The commenters were quick to reassure him. “This is distrustful,” said one. “You’re definitely not crazy for thinking this,” replied another.
According to a small study of 10 gay male couples published last month in the inimitably tilted Journal of Homosexuality, using PrEP and PEP while in a relationship, or simply expressing a desire to try them, has the potential to stir up mistrust between the partners, especially those in a monogamous relationship. The desire to take either biomedical prevention method is often associated with promiscuity or infidelity, drawing on longstanding harmful stereotypes about people who take PrEP.
"[If you want to start PrEP,] you’re gonna have all this unsafe sex,” said one of the men who participated in the study. “If we’re monogamous, like, why would you even need that?"
"Cheating,” his partner responded.
This kind of interpersonal stigma could be one of the many factors that explains why relatively few people are taking Truvada or Descovy, the only two brand-name drugs currently approved for use as PrEP in the United States, both made by Gilead Sciences. Despite the fact that many insurance providers cover Gilead’s exorbitant, $1,800 a month price tag for a single month’s supply of pills, only 35 percent of gay and bisexual men at high risk for HIV infection were using PrEP in 2017, according to numbers released by the Centers for Disease Control and Prevention last year.
That’s unfortunate, as PrEP is not just beneficial to an individual’s health—it can benefit a relationship, as well. “PrEP is probably one of the most powerful tools for HIV prevention,” according to Andrew Goodman, the Associate Director of Medicine at the Callen-Lorde Community Health Center in New York City. Anyone who wants to start PrEP and is able to access it should feel empowered to do so, he said.
“If someone in a relationship wants to get on PrEP, that’s not a judgment against their partner,” Goodman told VICE. “If they’re scared to bring it up with their partner, I would tell them to emphasize how this is an individual decision, something they’re doing to protect their own health.”
He also recommended asking a doctor or someone you trust to role-play that conversation beforehand, which he has done many times with patients in the past.
Thankfully, there are trusting partners out there who can get over their own bullshit and respect their loved one’s decision to start taking PrEP.
“It’s a margin of safety,” explained Mara, a middle-aged trans woman from New York City who spoke to VICE under a pseudonym for privacy reasons. “It might not even be needed, but you're just kind of adding an extra prophylactic layer over the possibility of being vector for somebody else. That’s a terrifying fucking thought.”
Mara and her cis wife of many years recently agreed to open up their marriage to other partners. For Mara, exploring her sexuality with other partners of all genders is a way to better understand her own identity now that she is “newly hatched,” as she described herself. She sees PrEP as an important measure to maintain both her and her wife’s negative HIV status—though, having witnessed the HIV epidemic since its inception, she still can’t quite believe that she can avoid getting the virus by taking a single pill every morning.
“I’m somebody who had to get blood tests in the ‘80s just because of a broken condom,” Mara said. “The landscape is so different for people of a certain vintage. Even eight years [after Truvada was approved for use as PrEP in the U.S.], it’s hard to imagine this is real.”
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This article originally appeared on VICE US.